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Sample records for bipolar patients treated

  1. Three-dimensional mapping of hippocampal anatomy in unmedicated and lithium-treated patients with bipolar disorder.

    PubMed

    Bearden, Carrie E; Thompson, Paul M; Dutton, Rebecca A; Frey, Benício N; Peluso, Marco A M; Nicoletti, Mark; Dierschke, Nicole; Hayashi, Kiralee M; Klunder, Andrea D; Glahn, David C; Brambilla, Paolo; Sassi, Roberto B; Mallinger, Alan G; Soares, Jair C

    2008-05-01

    Declarative memory impairments are common in patients with bipolar illness, suggesting underlying hippocampal pathology. However, hippocampal volume deficits are rarely observed in bipolar disorder. Here we used surface-based anatomic mapping to examine hippocampal anatomy in bipolar patients treated with lithium relative to matched control subjects and unmedicated patients with bipolar disorder. High-resolution brain magnetic resonance images were acquired from 33 patients with bipolar disorder (21 treated with lithium and 12 unmedicated), and 62 demographically matched healthy control subjects. Three-dimensional parametric mesh models were created from manual tracings of the hippocampal formation. Total hippocampal volume was significantly larger in lithium-treated bipolar patients compared with healthy controls (by 10.3%; p=0.001) and unmedicated bipolar patients (by 13.9%; p=0.003). Statistical mapping results, confirmed by permutation testing, revealed localized deficits in the right hippocampus, in regions corresponding primarily to cornu ammonis 1 subfields, in unmedicated bipolar patients, as compared to both normal controls (p=0.01), and in lithium-treated bipolar patients (p=0.03). These findings demonstrate the sensitivity of these anatomic mapping methods for detecting subtle alterations in hippocampal structure in bipolar disorder. The observed reduction in subregions of the hippocampus in unmedicated bipolar patients suggests a possible neural correlate for memory deficits frequently reported in this illness. Moreover, increased hippocampal volume in lithium-treated bipolar patients may reflect postulated neurotrophic effects of this agent, a possibility warranting further study in longitudinal investigations. PMID:17687266

  2. Bipolar Radiofrequency Neurotomy to Treat Neck and Back Pain in Patients with Automatic Implantable Cardioverter Defibrillator.

    PubMed

    Bautista, Alexander; Dadabayev, Alisher; Rosenquist, Ellen; Cheng, Jianguo

    2016-03-01

    We report 2 cases of successful treatment of neck and back pain with bipolar radiofrequency ablation (RFA) of the cervical and lumbar facet joints in patients with an automatic implantable cardioverter defibrillator (AICD).Two patients with complex cardiac histories and AICD devices were treated with bipolar RFA of the facet joints. One presented with axial neck pain and the other with axial back pain. The histories and physical examinations were consistent with facetogenic pain. Diagnostic medial branch block resulted in more than 70% pain relief lasting for several days, allowing patients to perform routine daily activities without significant pain. However, we were concerned about the use of conventional RFA of the medial branches of nerves for the fear of interference with the function of AICD by the RF currents and energy. We took advantage of the localized and limited current of bipolar RFA to perform this procedure for the cervical or lumbar facet joints avoiding any interference with the function of AICD. The procedures provided long-term pain relief to the patients, and marked improvement in their functional status without any evident complications related to the function of their AICD.This case report describes the safe and successful completion of bipolar RFA of the medial branch nerves to treat cervical and lumbar facetogenic pain in patients with AICD. This modality of treatment may be considered in patients with AICD. We are finding it to be increasingly common that patients who present with chronic neck and back pain have AICDs in place. PMID:27008309

  3. Calcium metabolism in lithium-treated patients. Relation to uni-bipolar dichotomy.

    PubMed

    Baastrup, P C; Christiansen, C; Transbøl, I

    1978-02-01

    The bone mineral content (BMC) together with biochemical indices of calcium metabolism were measured in 83 manic-depressive patients on long-term lithium therapy. The patients were diagnosed and divided into a unipolar and a bipolar group according to strict symptomatic course criteria. The patients with bipolar course had a significantly decreased BMC (88% of normal, P is less than 0.001), while the unipolar patients had normal BMC. Both groups had biochemical changes consistent with primary hyperparathyroidism. PMID:636904

  4. Drug Treated Schizophrenia, Schizoaffective and Bipolar Disorder Patients Evaluated by qEEG Absolute Spectral Power and Mean Frequency Analysis

    PubMed Central

    Wix-Ramos, Richard; Moreno, Xiomara; Capote, Eduardo; González, Gilbert; Uribe, Ezequiel

    2014-01-01

    Objective Research of electroencephalograph (EEG) power spectrum and mean frequency has shown inconsistent results in patients with schizophrenic, schizoaffective and bipolar disorders during medication when compared to normal subjects thus; the characterization of these parameters is an important task. Methods We applied quantitative EEG (qEEG) to investigate 38 control, 15 schizophrenic, 7 schizoaffective and 11 bipolar disorder subjects which remaine under the administration of psychotropic drugs (except control group). Absolute spectral power (ASP), mean frequency and hemispheric electrical asymmetry were measured by 19 derivation qEEG. Group mean values were compared with non parametrical Mann-Whitney test and spectral EEG maps with z-score method at p < 0.05. Results Most frequent drug treatments for schizophrenic patients were neuroleptic+antiepileptic (40% of cases) or 2 neuroleptics (33.3%). Schizoaffective patients received neuroleptic+benzodiazepine (71.4%) and for bipolar disorder patients neuroleptic+antiepileptic (81.8%). Schizophrenic (at all derivations except for Fp1, Fp2, F8 and T6) and schizoaffective (only at C3) show higher values of ASP (+57.7% and +86.1% respectively) compared to control group. ASP of bipolar disorder patients did not show differences against control group. The mean frequency was higher at Fp1 (+14.2%) and Fp2 (+17.4%) in bipolar disorder patients than control group, but no differences were found in frequencies between schizophrenic or schizoaffective patients against the control group. Majority of spectral differences were found at the left hemisphere in schizophrenic and schizoaffective but not in bipolar disorder subjects. Conclusion The present report contributes to characterize quantitatively the qEEG in drug treated schizophrenic, schizoaffective or bipolar disorder patients. PMID:24851121

  5. Ziprasidone as Adjunctive Therapy in Severe Bipolar Patients Treated with Clozapine

    PubMed Central

    Bartolommei, Natalia; Pensabene, Laura; Luchini, Federica; Benvenuti, Antonella; Di Paolo, Antonello; Cosentino, Luca; Mauri, Mauro; Lattanzi, Lorenzo

    2014-01-01

    Aim. To confirm the efficacy and tolerability of ziprasidone as adjunctive therapy in bipolar patients partially responding to clozapine or with persisting negative symptoms, overweight, or with metabolic syndrome. Methods. Eight patients with psychotic bipolar disorder were tested with the BPRS, the HAM-D, and the CGI at T0 and retested after 2 weeks (T1). Plasma clozapine and norclozapine levels and BMI were tested at T0 and T1. Results. Ziprasidone was well tolerated by all the patients. BPRS and HAM-D scores were reduced in all patients. BMI was reduced in patients with a BMI at T0 higher than 25. Plasma levels of clozapine and norclozapine showed an irregular course. PMID:25006524

  6. Characteristics of bipolar disorder patients treated with immediate- and extended-release quetiapine in a real clinical setting: a longitudinal, cohort study of 1761 patients

    PubMed Central

    Thuresson, Marcus; Ferntoft, Lena; Bodegard, Johan

    2015-01-01

    Objectives: The objective of this work was to study characteristics and clinical treatment patterns of bipolar disorder (BD) patients admitted to hospital and treated with quetiapine (immediate-release [IR] or extended-release [XR] formulations). Methods: BD patients admitted to hospital and prescribed quetiapine IR were followed by linking two Swedish nationwide registries; the hospitalization and drug dispense registries [ClinicalTrials.gov identifier: NCT01455961]. The study period was from 1 January 2008, to end of 31 December 2011. Data was primarily analysed using descriptive methods. Results: Quetiapine IR was used in 1761 patients of whom 1303 subsequently switched to XR (switch XR) and 458 remained on IR (continuous IR). At baseline, Switch XR patients were younger (−3.3 years), more frequently employed (+7.1%), had higher prevalence of single depressive episodes (+6.7%) and anxiety disorders (+5.8%), lower mean daily IR dose (−19.3%) and fewer medications for somatic disorders (−7.5%) than continuous IR patients. During follow up, the number of concomitant psychiatric medications was lower in switch XR patients (−6%) and higher in continuous IR patients (+6%). Mean daily quetiapine dose was 21% higher in switch XR versus continuous IR patients. Prescriptions of lower quetiapine dosages calculated below 50 mg per day in the XR switch and IR continuous groups were seen in 8% versus 10% of the patients, respectively. Conclusions: Differential use of quetiapine XR and IR in bipolar disorder patients with different and important characteristics was demonstrated. Patients who were switched to quetiapine XR had a higher psychiatric disease burden, were younger and had a higher degree of employment. These differences demonstrate the heterogeneity among bipolar disorder patients and indicate the need in clinical practice for individualized treatment to reduce the risk for both patient and society related losses. PMID:25653826

  7. Augmentation of light therapy in difficult-to-treat depressed patients: an open-label trial in both unipolar and bipolar patients

    PubMed Central

    Camardese, Giovanni; Leone, Beniamino; Serrani, Riccardo; Walstra, Coco; Di Nicola, Marco; Della Marca, Giacomo; Bria, Pietro; Janiri, Luigi

    2015-01-01

    Objectives We investigated the clinical benefits of bright light therapy (BLT) as an adjunct treatment to ongoing psychopharmacotherapy, both in unipolar and bipolar difficult-to-treat depressed (DTD) outpatients. Methods In an open-label study, 31 depressed outpatients (16 unipolar and 15 bipolar) were included to undergo 3 weeks of BLT. Twenty-five completed the treatment and 5-week follow-up. Main outcome measures Clinical outcomes were evaluated by the Hamilton Depression Rating Scale (HDRS). The Snaith–Hamilton Pleasure Scale and the Depression Retardation Rating Scale were used to assess changes in anhedonia and psychomotor retardation, respectively. Results The adjunctive BLT seemed to influence the course of the depressive episode, and a statistically significant reduction in HDRS scores was reported since the first week of therapy. The treatment was well-tolerated, and no patients presented clinical signs of (hypo)manic switch during the overall treatment period. At the end of the study (after 5 weeks from BLT discontinuation), nine patients (36%, eight unipolar and one bipolar) still showed a treatment response. BLT augmentation also led to a significant improvement of psychomotor retardation. Conclusion BLT combined with the ongoing pharmacological treatment offers a simple approach, and it might be effective in rapidly ameliorating depressive core symptoms of vulnerable DTD outpatients. These preliminary results need to be confirmed in placebo-controlled, randomized, double-blind clinical trial on larger samples. PMID:26396517

  8. Short-Term Effect of Percutaneous Bipolar Continuous Radiofrequency on Sacral Nerves in Patients Treated for Neurogenic Detrusor Overactivity After Spinal Cord Injury: A Randomized Controlled Feasibility Study

    PubMed Central

    Kim, Jin Hyun; Ahn, Sang Ho; Cho, Yun Woo; Kwak, Sang Gyu

    2015-01-01

    Objective To investigate the short-term effects of bipolar radiofrequency applied to sacral nerves to treat neurogenic detrusor overactivity in patients with spinal cord injury. Methods Ten patients with spinal cord injury with neurogenic detrusor overactivity were recruited. These subjects were randomized to two groups: intervention (n=5) and control (n=5), members of which received conventional treatment. Voiding diary, International Consultation on Incontinence Questionnaire (ICIQ) and the urinary incontinence quality of life scale (IQOL) data were obtained and an urodynamic study (UDS) was performed before and after intervention. In the intervention group, percutaneous bipolar continuous radiofrequency (CRF) was performed on both the S2 and S3 nerves in each patient. Results In a comparison of daily frequency and number of urinary incontinence and ICIQ and IQOL scores at baseline and at 1 and 3 months after intervention, all variables achieved a significant effect for time (p<0.05). Regarding UDS parameters, pre/post intervention differences between baseline and 3-month post-intervention for volume at maximal detrusor pressure during filling and reflex detrusor volume at first contraction were significantly different between the two groups (p<0.05). However, pre/post intervention differences in maximum cystometric capacity and maximum detrusor pressure during filling were not significant between the two groups (p>0.05). Conclusion Percutaneous bipolar CRF applied to sacral nerves might be an effective therapy for neurogenic overactive bladder that reduces urinary incontinence and improves quality of life. PMID:26605169

  9. Attention Deficit Hyperactivity Disorder Erroneously Diagnosed and Treated as Bipolar Disorder

    ERIC Educational Resources Information Center

    Atmaca, Murad; Ozler, Sinan; Topuz, Mehtap; Goldstein, Sam

    2009-01-01

    Objective: There is a dearth of literature on patients erroneously diagnosed and treated for bipolar disorder. Method: The authors report a case of an adult with attention deficit hyperactivity disorder erroneously diagnosed and treated for bipolar disorder for 6 years. At that point, methylphenidate was initiated. The patient was judged to be a…

  10. Validation of the Portuguese version of the Lithium Attitudes Questionnaire (LAQ) in bipolar patients treated with lithium: cross-over study

    PubMed Central

    2006-01-01

    Background Poor adherence to lithium is very common in bipolar patients and it is a frequent cause of recurrence during prophylactic treatment. Several reports suggest that attitudes of bipolar patients interfere with adherence to lithium. The Lithium Attitudes Questionnaire (LAQ) is a brief questionnaire developed as a means of identifying and grouping the problems patients commonly have with taking lithium regularly. The original version is validated in patients, but a validated version in Portuguese is not yet available. Methods One-hundred six patients with bipolar disorder (DSM-IV criteria) criteria under lithium treatment for at least one month were assessed using LAQ. LAQ is a brief questionnaire administered under interview conditions, which includes 19 items rating attitudes towards prophylactic lithium treatment. We analysed the internal consistency, concurrent validity, sensitivity and specificity of the Portuguese version of LAQ. Results The internal consistency, evaluated by Cronbach's alpha was 0.78. The mean total LAQ score was 4.1. Concurrent validity was confirmed by a negative correlation between plasma lithium concentration and total LAQ score (r = -0,198; p = 0.048). We analysed the scale's discriminative capacity revealing a sensitivity of 69% and a specificity of 71% in the identification of negative attitudes of bipolar patients. Conclusion The psychometric assessment of the Portuguese version of LAQ showed good internal consistency, sensitivity and specificity. The results were similar to the original version in relation to attitudes of bipolar patients towards lithium therapy. PMID:17121674

  11. Adaptation and validation of the Portuguese version of the Lithium Knowledge Test (LKT) of bipolar patients treated with lithium: cross-over study

    PubMed Central

    2006-01-01

    Objective Adherence problems are a common feature among bipolar patients. A recent study showed that lithium knowledge was the main difference between adherent and non adherents bipolar patients. The Lithium Knowledge Test (LKT), a brief questionnaire, was developed as a means of identifying aspects of patients' practical and pharmacological knowledge which are important if therapy is to be safe and effective. The original English version is validated in psychiatric population, but a validated Portuguese one is not yet available. Methods One hundred six patients selected were diagnosed with bipolar disorder (I or II) according to DSM-IV criteria and had to be on lithium treatment for at least one month. The LKT was administered on only one occasion. We analysed the internal consis tency, concurrent validity, sensitivity and specificity of the LKT for the detection of the knowledge about lithium treatment of bipolar patients. Results The internal consistency, evaluated by Cronbach's alpha was 0.596. The mean of total score LKT by bipolar patients was 9.0 (SD: 0.75) for men and 8.74 (SD: 0.44) for women. Concurrent validity based on plasma lithium concentration showed a significant correlation between the total LKT score and plasma lithium (r = 0,232; p = 0.020). The sensitivity was 84% and specificity was 81%. Conclusion LKT is a rapid, reliable instrument which appears to be as effective as a lengthier standard interview with a lithium clinic doctor, and which has a high level of acceptability to lithium patients. We found that the psychometric assessment of the Portuguese version of LKT showed good internal consistency, sensitivity and specificity. PMID:17147815

  12. Suicide attempts and clinical features of bipolar patients

    PubMed Central

    Berkol, Tonguç D.; İslam, Serkan; Kırlı, Ebru; Pınarbaşı, Rasim; Özyıldırım, İlker

    2016-01-01

    Objectives: To identify clinical predictors of suicide attempts in patients with bipolar disorder. Methods: This study included bipolar patients who were treated in the Psychiatry Department, Haseki Training and Research Hospital, Istanbul, Turkey, between 2013 and 2014; an informed consent was obtained from the participants. Two hundred and eighteen bipolar patients were assessed by using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis-I (SCID-I) in order to detect all possible psychiatric comorbid diagnoses. Clinical predictors of suicide attempts were examined in attempters and non-attempters. The study design was retrospective. Results: The lifetime suicide attempt rate for the entire sample was 19.2%. Suicide attempters with bipolar disorder had more lifetime comorbidity of eating disorder. Female gender and family history of mood disorder were significant predictors for suicide attempts. There was no difference between groups in terms of bipolar disorder subtype, onset age of bipolar disorder, total number of episodes, first and predominant episode type, suicide history in first degree relatives, severity of episodes, and hospitalization and being psychotic. Conclusion: Our study revealed that female gender, family history of mood disorder, and eating disorder are more frequent in bipolar patients with at least one suicide attempt. PMID:27279513

  13. Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia

    PubMed Central

    Depp, Colin A; Strassnig, Martin; Mausbach, Brent T; Bowie, Christopher R; Wolyniec, Paula; Thornquist, Mary H; Luke, James R; McGrath, John A; Pulver, Ann E; Patterson, Thomas L; Harvey, Philip D

    2014-01-01

    Objectives People with bipolar disorder or schizophrenia are at greater risk for obesity and other cardio-metabolic risks, and several prior studies have linked these risks to poorer cognitive ability. In a large ethnically homogenous outpatient sample, we examined associations among variables related to obesity, treated hypertension and/or diabetes, and cognitive abilities in these two patient populations. Methods In a study cohort of outpatients with either bipolar disorder (n = 341) or schizophrenia (n = 417), we investigated the association of self-reported body mass index and current use of medications for hypertension or diabetes with performance on a comprehensive neurocognitive battery. We examined sociodemographic and clinical factors as potential covariates. Results Patients with bipolar disorder were less likely to be overweight or obese than patients with schizophrenia, and also less likely to be prescribed medication for hypertension or diabetes. However, obesity and treated hypertension were associated with worse global cognitive ability in bipolar disorder (as well as with poorer performance on individual tests of processing speed, reasoning/problem-solving, and sustained attention), with no such relationships observed in schizophrenia. Obesity was not associated with symptom severity in either group. Conclusions Although less prevalent in bipolar disorder compared to schizophrenia, obesity was associated with substantially worse cognitive performance in bipolar disorder. This association was independent of symptom severity and not present in schizophrenia. Better understanding of the mechanisms and management of obesity may aid in efforts to preserve cognitive health in bipolar disorder. PMID:24725166

  14. [Pseudocholinesterase activity in type 1 bipolar patients].

    PubMed

    Ezzaher, Asma; Haj Mouhamed, Dhouha; Mechri, Anwar; Neffati, Fadoua; Douki, Wahiba; Gaha, Lotfi; Najjar, Mohamed Fadhel

    2012-01-01

    This study aims to investigate the variation of pseudocholinesterase activity (BuChE) in bipolar patients and to explore its relation to the clinical and therapeutic characteristics of this disease. Our study included 105 patients with bipolar disorder and 100 control subjects aged 38.7 ± 12.2 and 36.4 ± 15.7 y, respectively. BuChE was determined by kinetic methods on Cobas Integra 400 plus™. Compared with controls, patients had a significantly higher pseudocholinesterase activity. Moreover, this increase was significantly associated (p = 0.001) with bipolar disorder with sensibility of 58% and specificity of 62% at threshold of 7392 IU/L. There was no significant change in pseudocholinesterase activity in relation to illness episodes and treatment, whereas the lowest values of this activity were seen in euthymic patients and those taking psychotics. Therefore, this activity is a real interest in the biological monitoring of patients as a risk factor for neurodegenerative diseases associated with bipolar disorder. But it would be most useful to evaluate their interest as a predictor of bipolar disorder in patients at risk. PMID:22294139

  15. Unmet needs of bipolar disorder patients

    PubMed Central

    Hajda, Miroslav; Prasko, Jan; Latalova, Klara; Hruby, Radovan; Ociskova, Marie; Holubova, Michaela; Kamaradova, Dana; Mainerova, Barbora

    2016-01-01

    Background Bipolar disorder (BD) is a serious mental illness with adverse impact on the lives of the patients and their caregivers. BD is associated with many limitations in personal and interpersonal functioning and restricts the patients’ ability to use their potential capabilities fully. Bipolar patients long to live meaningful lives, but this goal is hard to achieve for those with poor insight. With progress and humanization of society, the issue of patients’ needs became an important topic. The objective of the paper is to provide the up-to-date data on the unmet needs of BD patients and their caregivers. Methods A systematic computerized examination of MEDLINE publications from 1970 to 2015, via the keywords “bipolar disorder”, “mania”, “bipolar depression”, and “unmet needs”, was performed. Results Patients’ needs may differ in various stages of the disorder and may have different origin and goals. Thus, we divided them into five groups relating to their nature: those connected with symptoms, treatment, quality of life, family, and pharmacotherapy. We suggested several implications of these needs for pharmacotherapy and psychotherapy. Conclusion Trying to follow patients’ needs may be a crucial point in the treatment of BD patients. However, many needs remain unmet due to both medical and social factors. PMID:27445475

  16. Thought Suppression in Patients With Bipolar Disorder

    PubMed Central

    Miklowitz, David J.; Alatiq, Yousra; Geddes, John R.; Goodwin, Guy M.; Williams, J. Mark G.

    2010-01-01

    Suppression of negative thoughts has been observed under experimental conditions among patients with major depressive disorder (MDD) but has never been examined among patients with bipolar disorder (BD). Patients with BD (n = 36), patients with MDD (n = 20), and healthy controls (n = 20) completed a task that required unscrambling 6-word strings into 5-word sentences, leaving out 1 word. The extra word allowed the sentences to be completed in a negative, neutral, or “hyperpositive” (manic/goal-oriented) way. Participants completed the sentences under conditions of cognitive load (rehearsing a 6-digit number), reward (a bell tone), load and reward, or neither load nor reward. We hypothesized that patients with BD would engage in more active suppression of negative and hyperpositive thoughts than would controls, as revealed by their unscrambling more word strings into negative or hyperpositive sentences. Under conditions of load or reward and in the absence of either load or reward, patients with BD unscrambled more negative sentences than did controls. Under conditions of reward, patients with BD unscrambled more negative sentences than did patients with MDD. Patients with BD also reported more use of negative thought suppression than did controls. These group differences in negative biases were no longer significant when current mood states were controlled. Finally, the groups did not differ in the proportion of hyperpositive sentence completions in any condition. Thought suppression may provide a critical locus for psychological interventions in BD. PMID:20455608

  17. Comparison of clinical and sociodemographic features of bipolar disorder patients with those of social anxiety disorder patients comorbid with bipolar disorder in Turkey

    PubMed Central

    Berkol, Tonguç D.; Kırlı, Ebru; Islam, Serkan; Pınarbaşı, Rasim; Özyıldırım, İlker

    2016-01-01

    Objectives: To assess the impact of social anxiety disorder (SAD) comorbidity on the clinical features, illness severity, and response to mood stabilizers in bipolar disorder (BD) patients. Methods: This retrospective study included bipolar patients that were treated at the Department of Psychiatry, Haseki Training and Research Hospital, Istanbul, Turkey in 2015, and who provided their informed consents for participation in this study. The study was conducted by assessing patient files retrospectively. Two hundred bipolar patients were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition axis-I (SCID-I) in order to detect all possible comorbid psychiatric diagnoses. The sample was split according to the presence of SAD comorbidity and the groups were compared. Results: The SAD comorbidity was detected in 17.5% (35/200) of the BD patients. The SAD comorbid bipolar patients were more educated, had earlier onset of BD, lower number of manic episodes, and more severe episodes. There was no difference between groups in terms of total number of episodes, hospitalization, suicidality, being psychotic, treatment response to lithium and anticonvulsants. Conclusion: Social anxiety disorder comorbidity may be associated with more severe episodes and early onset of BD. However, SAD comorbidity may not be related to treatment response in bipolar patients. PMID:26905355

  18. Experience of Subjective Symptoms in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Joe, Soohyun; Joo, Yeonho

    2008-01-01

    Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients. PMID:18303193

  19. Experience of subjective symptoms in euthymic patients with bipolar disorder.

    PubMed

    Joe, Soohyun; Joo, Yeonho; Kim, Seongyoon

    2008-02-01

    Bipolar patients often experience subjective symptoms even if they do not have active psychotic symptoms in their euthymic state. Most studies about subjective symptoms are conducted in schizophrenia, and there are few studies involving bipolar patients. We examined the nature of the subjective symptoms of bipolar patients in their euthymic state, and we also compared it to that of schizophrenia and normal control. Thirty bipolar patients, 25 patients with schizophrenia, and 21 normal control subjects were included. Subjective symptoms were assessed using the Korean version of the Frankfurter Beschwerde Fragebogen (K-FBF) and the Symptom Check List 90-R (SCL90-R). Euthymic state was confirmed by assessing objective psychopathology with the Positive and Negative Syndrome scale of Schizophrenia (PANSS), the Young Mania Rating Scale (YMRS), and the Montgomery Asberg Depression Rating Scale (MADRS). K-FBF score was significantly higher in bipolar patients than in normal controls, but similar to that in schizophrenia patients (F=5.86, p=0.004, R2=2033.6). In contrast, SCL90-R scores did not differ significantly among the three groups. Euthymic bipolar patients experience subjective symptoms that are more confined to cognitive domain. This finding supports the hypothesis that subtle cognitive impairments persists in euthymic bipolar patients. PMID:18303193

  20. Lithium might be associated with better decision-making performance in euthymic bipolar patients.

    PubMed

    Adida, Marc; Jollant, Fabrice; Clark, Luke; Guillaume, Sebastien; Goodwin, Guy M; Azorin, Jean-Michel; Courtet, Philippe

    2015-06-01

    Bipolar disorder is associated with impaired decision-making. Little is known about how treatment, especially lithium, influences decision-making abilities in bipolar patients when euthymic. We aimed at testing for an association between lithium medication and decision-making performance in remitted bipolar patients. Decision-making was measured using the Iowa Gambling Task in 3 groups of subjects: 34 and 56 euthymic outpatients with bipolar disorder, treated with lithium (monotherapy and lithium combined with anticonvulsant or antipsychotic) and without lithium (anticonvulsant, antipsychotic and combination treatment), respectively, and 152 matched healthy controls. Performance was compared between the 3 groups. In the 90 euthymic patients, the relationship between different sociodemographic and clinical variables and decision-making was assessed by stepwise multivariate regression analysis. Euthymic patients with lithium (p=0.007) and healthy controls (p=0.001) selected significantly more cards from the safe decks than euthymic patients without lithium, with no significant difference between euthymic patients with lithium and healthy controls (p=0.9). In the 90 euthymic patients, the stepwise linear multivariate regression revealed that decision-making was significantly predicted (p<0.001) by lithium dose, level of education and no family history of bipolar disorder (all p≤0.01). Because medication was not randomized, it was not possible to discriminate the effect of different medications. Lithium medication might be associated with better decision-making in remitted bipolar patients. A randomized trial is required to test for the hypothesis that lithium, but not other mood stabilizers, may specifically improve decision-making abilities in bipolar disorder. PMID:25840740

  1. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients

    PubMed Central

    García, Saínza; Martínez-Cengotitabengoa, Mónica; López-Zurbano, Saioa; Zorrilla, Iñaki; López, Purificación; Vieta, Eduard; González-Pinto, Ana

    2016-01-01

    Abstract Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients. PMID:27307187

  2. Cortical folding in patients with bipolar disorder or unipolar depression

    PubMed Central

    Penttilä, Jani; Paillère-Martinot, Marie-Laure; Martinot, Jean-Luc; Ringuenet, Damien; Wessa, Michèle; Houenou, Josselin; Gallarda, Thierry; Bellivier, Frank; Galinowski, André; Bruguière, Pascale; Pinabel, François; Leboyer, Marion; Olié, Jean-Pierre; Duchesnay, Edouard; Artiges, Eric; Mangin, Jean-François; Cachia, Arnaud

    2009-01-01

    Background Analysis of cortical folding may provide insight into neurodevelopment deviations, which, in turn, can predispose to depression that responds particularly poorly to medications. We hypothesized that patients with treatment-resistant depression would exhibit measurable alterations in cortical folding. Methods We computed hemispheric global sulcal indices (g-SIs) in T1-weighted magnetic resonance images obtained from 76 patients and 70 healthy controls. We separately searched for anatomic deviations in patients with bipolar disorder (16 patients with treatment-resistant depression, 25 with euthymia) and unipolar depression (35 patients with treatment-resistant depression). Results Compared with healthy controls, both groups of patients with treatment-resistant depression exhibited reduced g-SIs: in the right hemisphere among patients with bipolar disorder and in both hemispheres among those with unipolar depression. Patients with euthymic bipolar disorder did not differ significantly from depressed patients or healthy controls. Among patients with bipolar disorder who were taking lithium, we found positive correlations between current lithium dose and g-SIs in both hemispheres. Limitations We cannot estimate the extent to which the observed g-SI reductions are linked to treatment resistance and to what extent they are state-dependent. Furthermore, we cannot disentangle the impact of medications from that of the affective disorder. Finally, there is interindividual variation and overlap of g-SIs among patients and healthy controls that need to be considered when interpreting our results. Conclusion Reduced global cortical folding surface appears to be characteristic of patients with treatment-resistant depression, either unipolar or bipolar. In patients with bipolar disorder, treatment with lithium may modify cortical folding surface. PMID:19270763

  3. Bipolar depression: Managing patients with second generation antipsychotics.

    PubMed

    Avery, Lindsay M; Drayton, Shannon J

    2016-01-01

    Bipolar affective disorder is a debilitating illness that manifests as cyclical episodes of mood elevation and depression, but the treatment of the depressive episodes (i.e., bipolar depression) differs considerably from the treatment of major depressive disorder. In bipolar affective disorder, it is well known that patients spend a significantly greater amount of time in depressive episodes than manic or hypomanic episodes, yet there are currently just three Food and Drug Administration-approved agents for the treatment of bipolar depression: (1) olanzapine/fluoxetine combination (2) quetiapine, both immediate- and extended-release, and (3) lurasidone. The literature review presented here focuses on the clinical trials that led to the Food and Drug Administration-approval of these second generation antipsychotics in the treatment of bipolar depression. The discussion highlights key considerations regarding overall treatment strategies to aid clinicians in the selection of pharmacologic agents. Recommended monitoring parameters, potential adverse effects, and pertinent counseling points for second generation antipsychotics used in bipolar depression are included. PMID:27079776

  4. Family Functionality and Coping Attitudes of Patients with Bipolar Disorder.

    PubMed

    Çuhadar, Döndü; Savaş, Haluk Asuman; Ünal, Ahmet; Gökpınar, Fatma

    2015-10-01

    The coping of patients with prodromal syndromes prevents relapses, and the differences in coping strategies affect the results of bipolar disorder. The various functionality levels of bipolar disorder patients such as work, marital relations, parental abilities and social presentation are significantly related with how well they cope. The objective of this study was to determine the family functionality and coping attitudes of bipolar disorder patients. The study planned as a descriptive one was carried with 81 bipolar disorder patients. Personal description form, family assessment device and Coping Attitudes Scale were used as data acquisition tools. It was determined that the adaptive coping attitudes used most frequently by the patients were religious coping, positive reinterpretation, active coping, problem-focused coping and emotional focused coping, beneficial social support use, emotional social support use, planning, suppression of competing activities and restraint coping; maladaptive coping attitudes used most frequently by the patients were "focusing on the problem and venting of emotions and mental disengagement." It was determined that family functions affected the coping attitudes of patients and that the patients who evaluated family functions in a healthy manner made use of adaptive coping strategies more at a statistically significant level. PMID:25086849

  5. Increased Beta Frequency (15-30 Hz) Oscillatory Responses in Euthymic Bipolar Patients Under Lithium Monotherapy.

    PubMed

    Tan, Devran; Özerdem, Ayşegül; Güntekin, Bahar; Atagün, M Ilhan; Tülay, Elif; Karadağ, Figen; Başar, Erol

    2016-04-01

    The effect of lithium on neurocognition is not still fully explored. Brain oscillatory activity is altered in bipolar disorder. We aimed to assess the oscillatory responses of euthymic bipolar patients and how they are affected by lithium monotherapy. Event-related oscillations in response to visual target stimulus during an oddball paradigm in 16 euthymic drug-free and 13 euthymic lithium-treated bipolar patients were compared with 16 healthy controls. The maximum peak-to-peak amplitudes were measured for each subject's averaged beta (15-30 Hz) responses in the 0- to 300-ms time window over frontal (F3, Fz, F4), central (C3, Cz, C4), temporal (T7, T8), temporo-parietal (TP7, TP8), parietal (P3, Pz, P4), and occipital (O1, Oz, O2) areas. Patients under lithium monotherapy had significantly higher beta responses to visual target stimuli than healthy controls (P=.017) and drug-free patients (P=.015). The increase in beta response was observed at all electrode locations, however, the difference was statistically significant for the left (T7; P=.016) and right (T8; P=.031) temporal beta responses. Increased beta responses in drug-free patients and further significant increase in lithium-treated patients may be indicative of a core pathophysiological process of bipolar disorder and how it is affected by lithium. Whether the finding corresponds to lithium's corrective effect on the underlying pathology or to its neurocognitive side effect remains to be further explored. In either case, the finding is a sign that the oscillatory activity may be useful in tracking medication effect in bipolar disorder. PMID:25465436

  6. Clinical features, comorbidity, and cognitive impairment in elderly bipolar patients

    PubMed Central

    Rise, Ida Vikan; Haro, Josep Maria; Gjervan, Bjørn

    2016-01-01

    Introduction Data specific to late-life bipolar disorder (BD) are limited. Current research is sparse and present guidelines are not adapted to this group of patients. Objectives We present a literature review on clinical characteristics, comorbidities, and cognitive impairment in patients with late-life BD. This review discusses common comorbidities that affect BD elders and how aging might affect cognition and treatment. Methods Eligible studies were identified in MedLine by the Medical Subject Headings terms “bipolar disorder” and “aged”. We only included original research reports published in English between 2012 and 2015. Results From 414 articles extracted, 16 studies were included in the review. Cardiovascular and respiratory conditions, type II diabetes, and endocrinological abnormalities were observed as highly prevalent. BD is associated with a high suicide risk. Bipolar elderly had an increased risk of dementia and performed worse on cognitive screening tests compared to age-matched controls across different levels of cognition. Despite high rates of medical comorbidity among bipolar elderly, a systematic under-recognition and undertreatment of cardiovascular disease have been suggested. Conclusion There was a high burden of physical comorbidities and cognitive impairment in late-life BD. Bipolar elderly might be under-recorded and undertreated in primary medical care, indicating that this group needs an adapted clinical assessment and specific clinical guidelines need to be established. PMID:27274256

  7. Identification of MAC1: A Small Molecule That Rescues Spindle Bipolarity in Monastrol-Treated Cells.

    PubMed

    Al-Obaidi, Naowras; Mitchison, Timothy J; Crews, Craig M; Mayer, Thomas U

    2016-06-17

    The genetic integrity of each organism is intimately tied to the correct segregation of its genome during mitosis. Insights into the underlying mechanisms are fundamental for both basic research and the development of novel strategies to treat mitosis-relevant diseases such as cancer. Due to their fast mode of action, small molecules are invaluable tools to dissect mitosis. Yet, there is a great demand for novel antimitotic compounds. We performed a chemical genetic suppression screen to identify compounds that restore spindle bipolarity in cells treated with Monastrol, an inhibitor of the mitotic kinesin Eg5. We identified one compound-MAC1-that rescued spindle bipolarity in cells lacking Eg5 activity. Mechanistically, MAC1 induces the formation of additional microtubule nucleation centers, which allows kinesin Kif15-dependent bipolar spindle assembly in the absence of Eg5 activity. Thus, our chemical genetic suppression screen revealed novel unexpected insights into the mechanism of spindle assembly in mammalian cells. PMID:27121275

  8. The relationship between religious involvement and clinical status of patients with bipolar disorder

    PubMed Central

    Cruz, Mario; Pincus, Harold Alan; Welsh, Deborah E; Greenwald, Devra; Lasky, Elaine; Kilbourne, Amy M

    2009-01-01

    Objective Religion and spirituality are important coping strategies in depression but have been rarely studied within the context of bipolar disorder. The present study assessed the association between different forms of religious involvement and the clinical status of individuals treated for bipolar disorder. Methods A cross-sectional observation study of follow-up data from a large cohort study of patients receiving care for bipolar disorder (n = 334) at an urban Veterans Affairs mental health clinic was conducted. Bivariate and multivariate analyses were performed to assess the association between public (frequency of church attendance), private (frequency of prayer/meditation), as well as subjective forms (influence of beliefs on life) of religious involvement and mixed, manic, depressed, and euthymic states when demographic, anxiety, alcohol abuse, and health indicators were controlled. Results Multivariate analyses found significant associations between higher rates of prayer/meditation and participants in a mixed state [odds ratio (OR) = 1.29; 95% confidence interval (CI) = 1.10-1.52, chi square = 9.42, df = 14, p < 0.05], as well as lower rates of prayer/meditation and participants who were euthymic (OR = 0.84; 95% CI = 0.72-0.99, chi square = 4.60, df = 14, p < 0.05). Depression and mania were not associated with religious involvement. Conclusions Compared to patients with bipolar disorder in depressed, manic, or euthymic states, patients in mixed states have more active private religious lives. Providers should assess the religious activities of individuals with bipolar disorder in mixed states and how they may complement/deter ongoing treatment. Future longitudinal studies linking bipolar states, religious activities, and treatment-seeking behaviors are needed. PMID:20148868

  9. The influence of lithium on hippocampal volume in elderly bipolar patients: a study using voxel-based morphometry.

    PubMed

    Zung, S; Souza-Duran, F L; Soeiro-de-Souza, M G; Uchida, R; Bottino, C M; Busatto, G F; Vallada, H

    2016-01-01

    Recent studies have demonstrated that lithium (Li) exerts neuronal protective and regenerative effects both in vitro and in vivo. However, the effects of long-term Li treatment in the brain areas associated with memory impairment of elderly bipolar patients are still unknown. The aim of this study was to compare the hippocampal volumes of elderly bipolar patients using Li, elderly bipolar patients not using Li and healthy controls. Sociodemographic, clinical and magnetic resonance imaging data from 30 elderly euthymic bipolar patients who had been using Li for an average of >61 months; 27 elderly euthymic bipolar patients not taking Li for an average of 45 months; and 22 elderly healthy controls were analyzed. Volumetric differences in the hippocampus between groups were investigated with voxel-based morphometry (VBM) based on the Statistical Parametric Mapping technique. No statistical differences in sociodemographic and clinical characteristics and course of bipolar disorder between the two bipolar groups were observed. Using small volume correction in the VBM analysis (analysis of variance (ANOVA)), one voxel cluster of statistical significance was detected in the left hippocampus (P<0.05 corrected for multiple comparisons, extent threshold >10 voxels). Post hoc unpaired t-tests revealed increased left hippocampal volume in the Li-treated group compared with the non-Li-treated group, and decreased left hippocampal volume in the non-Li group relative to controls. Additional exploratory two-group comparisons indicated trends toward reduced right-hippocampal volumes in the non-Li-treated group relative to both the Li-treated group and controls. The findings suggested that the use of Li may influence the volume of the hippocampus, possibly due to its neuroprotective effects. PMID:27351600

  10. The influence of lithium on hippocampal volume in elderly bipolar patients: a study using voxel-based morphometry

    PubMed Central

    Zung, S; Souza-Duran, F L; Soeiro-de-Souza, M G; Uchida, R; Bottino, C M; Busatto, G F; Vallada, H

    2016-01-01

    Recent studies have demonstrated that lithium (Li) exerts neuronal protective and regenerative effects both in vitro and in vivo. However, the effects of long-term Li treatment in the brain areas associated with memory impairment of elderly bipolar patients are still unknown. The aim of this study was to compare the hippocampal volumes of elderly bipolar patients using Li, elderly bipolar patients not using Li and healthy controls. Sociodemographic, clinical and magnetic resonance imaging data from 30 elderly euthymic bipolar patients who had been using Li for an average of >61 months; 27 elderly euthymic bipolar patients not taking Li for an average of 45 months; and 22 elderly healthy controls were analyzed. Volumetric differences in the hippocampus between groups were investigated with voxel-based morphometry (VBM) based on the Statistical Parametric Mapping technique. No statistical differences in sociodemographic and clinical characteristics and course of bipolar disorder between the two bipolar groups were observed. Using small volume correction in the VBM analysis (analysis of variance (ANOVA)), one voxel cluster of statistical significance was detected in the left hippocampus (P<0.05 corrected for multiple comparisons, extent threshold >10 voxels). Post hoc unpaired t-tests revealed increased left hippocampal volume in the Li-treated group compared with the non-Li-treated group, and decreased left hippocampal volume in the non-Li group relative to controls. Additional exploratory two-group comparisons indicated trends toward reduced right-hippocampal volumes in the non-Li-treated group relative to both the Li-treated group and controls. The findings suggested that the use of Li may influence the volume of the hippocampus, possibly due to its neuroprotective effects. PMID:27351600

  11. Strategies for Monitoring Outcomes in Patients With Bipolar Disorder

    PubMed Central

    2010-01-01

    Practical strategies are available for primary care physicians to monitor psychiatric and medical outcomes as well as treatment adherence in patients with bipolar disorder. Current depressive symptoms can be assessed with tools like the 9-item Patient Health Questionnaire or Beck Depression Inventory. Lifetime presence or absence of manic or hypomanic symptoms can be assessed using the Mood Disorder Questionnaire (MDQ). These measures can be completed quickly by patients prior to appointments. Sensitivity of such ratings, particularly the MDQ, can be increased by having a significant other also rate the patient. Clinicians should also screen mood disorder patients for psychiatric comorbidities that are common in this population such as anxiety and substance use disorders. While patients with bipolar disorder may commonly be nonadherent with prescribed medication regimens, strategies that can help include having frank discussions with the patient, selecting medication collaboratively, adding psychotherapy with a psychoeducation element, monitoring appointment-keeping, using patient self-reports of medication-taking, enlisting the aid of significant others, and measuring plasma drug levels. Medical monitoring is needed to assess the safety and tolerability of psychotropic medications. All of the approved medications for bipolar disorder have at least 1 boxed warning for serious side effects, but are also associated with other common management-limiting side effects such as sedation, tremor, unsteadiness, restlessness, nausea, vomiting, diarrhea, constipation, weight gain, and metabolic problems. Routine monitoring is particularly needed for obesity, metabolic syndrome, and cardiovascular disorders, which lead to high rates of medical morbidity and mortality in patients with bipolar disorder. Monitoring protocols such as the one recommended by the American Diabetes Association for patients taking second-generation antipsychotics can be used for regular assessment

  12. Treating Insomnia Improves Mood State, Sleep, and Functioning in Bipolar Disorder: A Pilot Randomized Controlled Trial

    PubMed Central

    Harvey, Allison G.; Soehner, Adriane M.; Kaplan, Kate A.; Hein, Kerrie; Lee, Jason; Kanady, Jennifer; Rabe-Hesketh, Sophia; Neylan, Thomas C.; Li, Descartes; Ketter, Terence A.; Buysse, Daniel J.

    2015-01-01

    Objective To determine if a treatment for interepisode bipolar disorder I patients with insomnia improves mood state, sleep, and functioning. Method Alongside psychiatric care, interepisode bipolar disorder I participants with insomnia were randomly allocated to a bipolar disorder–specific modification of cognitive behavior therapy for insomnia (CBTI-BP; n = 30) or psychoeducation (PE; n = 28) as a comparison condition. Outcomes were assessed at baseline, the end of 8 sessions of treatment, and 6 months later. This pilot was conducted to determine initial feasibility and generate effect size estimates. Results During the 6-month follow-up, the CBTI-BP group had fewer days in a bipolar episode relative to the PE group (3.3 days vs. 25.5 days). The CBTI-BP group also experienced a significantly lower hypomania/mania relapse rate (4.6% vs. 31.6%) and a marginally lower overall mood episode relapse rate (13.6% vs. 42.1%) compared with the PE group. Relative to PE, CBTI-BP reduced insomnia severity and led to higher rates of insomnia remission at posttreatment and marginally higher rates at 6 months. Both CBTI-BP and PE showed statistically significant improvement on selected sleep and functional impairment measures. The effects of treatment were well sustained through follow-up for most outcomes, although some decline on secondary sleep benefits was observed. Conclusions CBTI-BP was associated with reduced risk of mood episode relapse and improved sleep and functioning on certain outcomes in bipolar disorder. Hence, sleep disturbance appears to be an important pathway contributing to bipolar disorder. The need to develop bipolar disorder–specific sleep diary scoring standards is highlighted. Public Health Significance This study suggests that an intervention to improve sleep and circadian functioning reduces risk of relapse and improves sleep and overall functioning among individuals who meet diagnostic criteria for bipolar disorder. PMID:25622197

  13. Electrical mapping in bipolar disorder patients during the oddball paradigm.

    PubMed

    Di Giorgio Silva, Luiza Wanick; Cartier, Consuelo; Cheniaux, Elie; Novis, Fernanda; Silveira, Luciana Angélica; Cavaco, Paola Anaquim; de Assis da Silva, Rafael; Batista, Washington Adolfo; Tanaka, Guaraci Ken; Gongora, Mariana; Bittencourt, Juliana; Teixeira, Silmar; Basile, Luis Fernando; Budde, Henning; Cagy, Mauricio; Ribeiro, Pedro; Velasques, Bruna

    2016-01-01

    Bipolar disorder (BD) is characterized by an alternated occurrence between acute mania episodes and depression or remission moments. The objective of this study is to analyze the information processing changes in BP (Bipolar Patients) (euthymia, depression and mania) during the oddball paradigm, focusing on the P300 component, an electric potential of the cerebral cortex generated in response to external sensorial stimuli, which involves more complex neurophysiological processes related to stimulus interpretation. Twenty-eight bipolar disorder patients (BP) (17 women and 11 men with average age of 32.5, SD: 9.5) and eleven healthy controls (HC) (7 women and 4 men with average age of 29.78, SD: 6.89) were enrolled in this study. The bipolar patients were divided into 3 major groups (i.e., euthymic, depressive and maniac) according to the score on the Clinical Global Impression--Bipolar Version (CGI-BP). The subjects performed the oddball paradigm simultaneously to the EEG record. EEG data were also recorded before and after the execution of the task. A one-way ANOVA was applied to compare the P300 component among the groups. After observing P300 and the subcomponents P3a and P3b, a similarity of amplitude and latency between euthymic and depressive patients was observed, as well as small amplitude in the pre-frontal cortex and reduced P3a response. This can be evidence of impaired information processing, cognitive flexibility, working memory, executive functions and ability to shift the attention and processing to the target and away from distracting stimuli in BD. Such neuropsychological impairments are related to different BD symptoms, which should be known and considered, in order to develop effective clinical treatment strategies. PMID:26551764

  14. Efficacy of bipolar release in neglected congenital muscular torticollis patients.

    PubMed

    Seyhan, Nevra; Jasharllari, Lorenc; Keskin, Mustafa; Savacı, Nedim

    2012-06-01

    Surgical correction of the congenital muscular torticollis (CMT) is recommended for patients with unsuccessful conservative treatment. The aim of this study is to evaluate the efficacy of surgical release of congenital muscular torticollis in neglected cases. We retrospectively evaluated the data of our patients in terms of age, sex, clinical presentation, localization of the lesion, diagnostic tests, and additional abnormalities. The age at operation ranged from 6 to 23 years. Complete muscular release as determined by pre-operative and postoperative range of motion measurements was achieved in all of the patients by bipolar release. In this study, neck motion and head tilt showed marked improvement with surgical treatment in cases with CMT who were admitted to the hospital lately. Congenital muscular torticollis patients can benefit from surgical intervention above the age of 5. Bipolar release is an adequate and complication-free method. PMID:22045346

  15. ESPECTRA: Searching the Bipolar Spectrum in Eating Disorder patients

    PubMed Central

    2011-01-01

    Background Bipolar Disorder (BD) is a chronic, recurrent and highly prevalent illness. Despite the need for correct diagnosis to allow proper treatment, studies have shown that reaching a diagnosis can take up to ten years due to the lack of recognition of the broader presentations of BD. Frequent comorbidities with other psychiatric disorders are a major cause of misdiagnosis and warrant thorough evaluation. Methods/Design ESPECTRA (Occurrence of Bipolar Spectrum Disorders in Eating Disorder Patients) is a single-site cross-sectional study involving a comparison group, designed to evaluate the prevalence of bipolar spectrum in an eating disorder sample. Women aged 18-45 years will be evaluated using the SCID-P and Zurich criteria for diagnosis and the HAM-D, YOUNG, SCI-MOODS, HCL-32, BIS-11, BSQ, WHOQoL and EAS instruments for rating symptoms and measuring clinical correlates. Discussion The classificatory systems in psychiatry are based on categorical models that have been criticized for simplifying the diagnosis and leading to an increase in comorbidities. Some dimensional approaches have been proposed aimed at improving the validity and reliability of psychiatric disorder assessments, especially in conditions with high rates of comorbidity such as BD and Eating Disorder (ED). The Bipolar Spectrum (BS) remains under-recognized in clinical practice and its definition is not well established in current diagnostic guidelines. Broader evaluation of psychiatric disorders combining categorical and dimensional views could contribute to a more realistic understanding of comorbidities and help toward establishing a prognosis. PMID:21489298

  16. Lower paraoxonase 1 activity in Tunisian bipolar I patients

    PubMed Central

    2010-01-01

    Background The purpose of this study was to investigate the variations of paraoxonase activity and lipid profile in bipolar I patients, and the association of this activity with the sociodemographic, clinical and therapeutic characteristics of this population. Patients and methods Our study included 66 patients with bipolar I disorder and 64 controls aged 37.9 ± 12.6 and 36.3 ± 18.2 years, respectively. Paraoxonase activity was determined by kinetic methods; high-density lipoprotein cholesterol (c-HDL), low-density lipoprotein cholesterol (c-LDL), triglycerides and total cholesterol were determined by enzymatic methods; apolipoprotein (Apo)A1, ApoB and lipoprotein (a) (Lp(a)) were determined by immunoturbidimetry using Konelab 30 equipment (Thermo Scientific). Results Compared with controls, patients had a significantly lower paraoxonase activity and ApoA1 level, and significantly higher total cholesterol, c-LDL and Lp(a) level and ApoB/ApoA1 ratio. Furthermore, paraoxonase activity was significantly correlated with c-HDL values (r = 0.5612; P < 0.001). The lowest paraoxonase activity was noted in relation to age and body mass index (BMI). Moreover, it was associated with gender but not with smoking and alcohol consumption status. In patients, there was no significant change in paraoxonase activity in relation to illness episodes, whereas the lowest values of this activity were seen in manic patients. In contrast, paraoxonase activity was significantly associated with treatment. Indeed, patients taking lithium had the lowest levels. Conclusions Bipolar patients had a significant decrease in paraoxonase activity and perturbations in their lipid profile that contribute to increased risk of cardiovascular diseases. Decrease in this activity was significantly associated with treatment with lithium but not with sociodemographic and clinical characteristics. Therefore, such patients require specific care, particularly with regard to their lipid profile. PMID:20964824

  17. Synchronization of EEG activity in patients with bipolar disorder

    NASA Astrophysics Data System (ADS)

    Panischev, O. Yu; Demin, S. A.; Muhametshin, I. G.; Demina, N. Yu

    2015-12-01

    In paper we apply the method based on the Flicker-Noise Spectroscopy (FNS) to determine the differences in frequency-phase synchronization of the cortical electroencephalographic (EEG) activities in patients with bipolar disorder (BD). We found that for healthy subjects the frequency-phase synchronization of EEGs from long-range electrodes was significantly better for BD patients. In BD patients a high synchronization of EEGs was observed only for short-range electrodes. Thus, the FNS is a simple graphical method for qualitative analysis can be applied to identify the synchronization effects in EEG activity and, probably, may be used for the diagnosis of this syndrome.

  18. Risk factors for an anxiety disorder comorbidity among Thai patients with bipolar disorder: results from the Thai Bipolar Disorder Registry

    PubMed Central

    Paholpak, Suchat; Kongsakon, Ronnachai; Pattanakumjorn, Wasana; Kanokvut, Roongsang; Wongsuriyadech, Wiroj; Srisurapanont, Manit

    2014-01-01

    Background The aim of the study was to determine in a clinical setting the risk factors for current anxiety disorder (AD) comorbidity among Thai patients with bipolar disorder (BD), being treated under the Thai Bipolar Disorder Registry Project (TBDR). Methods The TBDR was a multisite naturalistic study conducted at 24 psychiatric units (ie, at university, provincial mental, and government general hospitals) between February 2009 and January 2011. Participants were in- or out-patients over 18 years of age who were diagnosed with BD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Instruments used in this study included the Thai Mini International Neuropsychiatric Interview version 5; Thai Montgomery–Åsberg Depression Rating Scale (MADRS); Thai Young Mania Rating Scale; Clinical Global Impression of Bipolar Disorder-Severity (CGI-BP-S), CGI-BP-S-mania, CGI-BPS-depression, and CGI-BP-S-overall BP illness; and the Thai SF-36 quality of life questionnaire. Results Among the 424 BD patients, 404 (95.3%) had BD type I. The respective mean ± standard deviation of age of onset of mood disturbance, first diagnosis of BD, and first treatment of BD was 32.0±11.9, 36.1±12.2, and 36.2±12.2 years. The duration of illness was 10.7±9.0 years. Fifty-three (12.5%) of the 424 participants had a current AD while 38 (9%) had a substance use disorder (SUD). The univariate analysis revealed 13 significant risks for current AD comorbidity, which the multivariate analysis narrowed to age at first diagnosis of BD (odds ratio =0.95, P<0.01), family history of SUD (odds ratio =2.18, P=0.02), and having a higher current MADRS score (odds ratio =1.11, P<0.01). Conclusion A diagnosis of AD comorbid with BD is suggested by early-age onset of BD together with a higher MADRS score and a family history of SUD. The likelihood of AD comorbidity decreases by 5% with each passing year; early-age onset of BD is a risk while later age onset is protective. Our

  19. Perceptions of social dominance through facial emotion expressions in euthymic patients with bipolar I disorder.

    PubMed

    Kim, Sung Hwa; Ryu, Vin; Ha, Ra Yeon; Lee, Su Jin; Cho, Hyun-Sang

    2016-04-01

    The ability to accurately perceive dominance in the social hierarchy is important for successful social interactions. However, little is known about dominance perception of emotional stimuli in bipolar disorder. The aim of this study was to investigate the perception of social dominance in patients with bipolar I disorder in response to six facial emotional expressions. Participants included 35 euthymic patients and 45 healthy controls. Bipolar patients showed a lower perception of social dominance based on anger, disgust, fear, and neutral facial emotional expressions compared to healthy controls. A negative correlation was observed between motivation to pursue goals or residual manic symptoms and perceived dominance of negative facial emotions such as anger, disgust, and fear in bipolar patients. These results suggest that bipolar patients have an altered perception of social dominance that might result in poor interpersonal functioning. Training of appropriate dominance perception using various emotional stimuli may be helpful in improving social relationships for individuals with bipolar disorder. PMID:26995253

  20. Risk Factors Associated with Dislocation after Bipolar Hemiarthroplasty in Elderly Patients with Femoral Neck Fracture

    PubMed Central

    Kim, Yeesuk; Kim, Joon-Kuk; Joo, Il-Han; Hwang, Kyu-Tae

    2016-01-01

    Purpose We investigated the incidence and time of dislocation and other factors associated with dislocation of bipolar hemiarthroplasty related to the treatment of femoral neck fracture in old age patients. Materials and Methods Between January 2002 and April 2014, 498 femoral neck fractures (467 patients) were treated with bipolar hemiarthroplasty and included in this study. All surgeries were performed using the postero-lateral approach. The incidence of dislocation was investigated. A comparative analysis between a control group and dislocation group was performed with respect to patient factors including age, gender, body mass index, comorbidities, the ASA (American Society of Anesthesiologists) score, mental status and center-edge angle, and surgical factors including type of femoral stem, leg length discrepancy, femoral offset and method of short external rotator (SER) reconstruction. Results The incidence of dislocation was 3.8%, and the dislocation occurred on average 2.2 months (range, 0.6-6.5 months) after operation. No difference in patient-related factors was observed between the two groups. However, a smaller center edge (CE) angle was observed in the dislocation group (42.1°±3.2° vs. 46.9°±5.4°, P<0.001), and significantly lower incidence of dislocation was observed in tendon to bone repair group (0.7% vs 7.8%, P<0.001). Conclusion SERs should be repaired using the tendon-to-bone repair method to reduce dislocation rate in elderly patients who undergo bipolar hemiarthroplasty using the postero-lateral approach due to femoral neck fracture. In addition, patients with smaller CE angle should be carefully monitored due to high incidence of dislocation. PMID:27536652

  1. Segregation and linkage analyses in families of patients with bipolar, unipolar, and schizoaffective mood disorders.

    PubMed Central

    Goldin, L R; Gershon, E S; Targum, S D; Sparkes, R S; McGinniss, M

    1983-01-01

    Hypotheses of single major locus transmission (autosomal and X chromosome) of major affective disorder (i.e., bipolar, unipolar, and schizoaffective) are tested using the Elston-Stewart likelihood method of pedigree segregation analysis. The sample consists of families of varying size ascertained through patients treated at the National Institute of Mental Health in Bethesda, Maryland. We test hypotheses on subsamples of families according to: (1) diagnosis of proband (75 bipolar I, 22 bipolar II, 18 unipolar, and six schizoaffective); (2) extreme value of a biological trait in the proband ("low" monoamine oxidase, "low" cerebrospinal fluid serotonin metabolite 5-HIAA); and (3) positive response to lithium in the proband. We cannot find evidence for single major locus transmission of major affective disorder from segregation analysis in any subsample of family even when the diagnostic classification of ill phenotypes is widened to include possible affective "spectrum" diagnoses. In addition, linkage studies of 21 autosomal markers do not provide evidence for single major locus transmission of illness. The maximum lod score, found for 30 families at the MNS locus, was 1.39 at 20% recombination. PMID:6837575

  2. Bcl-2 associated with severity of manic symptoms in bipolar patients in a manic phase.

    PubMed

    Chen, Wei-Ting; Huang, Tiao-Lai; Tsai, Meng-Chang

    2015-02-28

    B cell lymphoma protein-2 (Bcl-2) may contribute to the pathophysiology of bipolar disorder, and may be involved in the therapeutic action of anti-manic drugs. The aim of this study was to investigate serum levels of Bcl-2 in bipolar patients in a manic phase, and evaluate the Bcl-2 changes after treatment. We consecutively enrolled 23 bipolar inpatients in a manic phase and 40 healthy subjects; 20 bipolar patients were followed up with treatment. Serum Bcl-2 levels were measured with assay kits. All 20 patients were evaluated by examining the correlation between Bcl-2 levels and Young Mania Rating Scale (YMRS) scores, using Spearman׳s correlation coefficients. The serum Bcl-2 levels in bipolar patients in a manic phase were higher than in healthy subjects, but without a significant difference. The YMRS scores were significantly negatively associated with serum Bcl-2 levels (p=0.042). Bcl-2 levels of the 20 bipolar patients were measured at the end of treatment. Using the Wilcoxon Signed Rank test, we found no significant difference in the Bcl-2 levels of bipolar patients after treatment. Our results suggest that Bcl-2 levels might be an indicator of severity of manic symptoms in bipolar patients in a manic phase. PMID:25563670

  3. Predominant mania course in Indian patients with bipolar I disorder.

    PubMed

    Rangappa, Sushma Bilichodu; Munivenkatappa, Shashidhara; Narayanaswamy, Janardhanan C; Jain, Sanjeev; Reddy, Y C Janardhan

    2016-08-01

    Many long-term follow-up studies suggest that bipolar disorder (BD) is highly recurrent and that depressive episodes are commoner than hypomania/manic episodes. However, some studies from tropical countries including India suggest that the patients experience a greater proportion of manic episodes than depressive episodes. The aim of the present study was to examine the course of BD type 1 (BD I) in a sample of hospitalized Indian subjects. We examined the clinical course of 285 BD I subjects with at least 5 years of illness using standard life charting method. These subjects were hospitalized between October 2010 and October 2012. The predominant polarity (having at least two-thirds of their lifetime episodes at one polarity) was mania (79%). Unipolar mania (≥ 3 mania episodes and no episodes of depression) was observed in 48% of the subjects. The frequency of rapid cycling course was noted in 2.5% of the subjects. Predominant manic polarity group had the illness onset mostly with a manic episode (88.9%) and the predominant depressive polarity group with a depressive episode (73.8%). Mania was the predominant polarity with a high rate of unipolar mania and a majority of the subjects had greater number of manic episodes than depressive/mixed episodes. The onset polarity determined the predominant polarity during the course of illness. Predominantly, mania course could have significant implications in the treatment of bipolar disorder. PMID:27520890

  4. Characteristics of stress-coping behaviors in patients with bipolar disorders.

    PubMed

    Moon, Eunsoo; Chang, Jae Seung; Choi, Sungwon; Ha, Tae Hyon; Cha, Boseok; Cho, Hyun Sang; Park, Je Min; Lee, Byung Dae; Lee, Young Min; Choi, Yoonmi; Ha, Kyooseob

    2014-08-15

    Appropriate stress-coping strategies are needed to improve the outcome in the treatment of bipolar disorders, as stressful life events may aggravate the course of the illness. The aim of this study was to compare stress-coping behaviors between bipolar patients and healthy controls. A total of 206 participants comprising 103 bipolar patients fulfilling the Diagnostic and Statistical Manual for Axis I disorder fourth edition (DSM-IV) diagnostic criteria for bipolar I and II disorders and controls matched by age and sex were included in this study. Stress-coping behaviors were assessed using a 53-item survey on a newly-designed behavioral checklist. The characteristics of stress-coping behaviors between the two groups were compared by using t-test and factor analysis. Social stress-coping behaviors such as 'journey', 'socializing with friends', and 'talking something over' were significantly less frequent in bipolar patients than controls. On the other hand, pleasurable-seeking behaviors such as 'smoking', 'masturbation', and 'stealing' were significantly more frequent in bipolar patients than controls. These results suggest that bipolar patients may have more maladaptive stress-coping strategies than normal controls. It is recommended to develop and apply psychosocial programs to reduce maladaptive stress-coping behaviors of bipolar patients. PMID:24803186

  5. Assessment of risk factors related to suicide attempts in patients with bipolar disorder.

    PubMed

    Song, Joo Yun; Yu, Han Young; Kim, Se Hyun; Hwang, Samuel S-H; Cho, Hyun-Sang; Kim, Yong Sik; Ha, Kyooseob; Ahn, Yong Min

    2012-11-01

    We compared the characteristics of patients with bipolar disorder with and without a history of suicide attempts to identify the risk factors of suicide in this disorder. Among 212 patients with bipolar disorder, 44 (21.2%) patients had histories of suicide attempts. Suicide attempters were younger and more likely to be diagnosed with bipolar II. The variables that differentiated those who did from those who did not attempt suicide included age at first contact, lifetime history of antidepressant use, major depressive episode, mixed episode, auditory hallucinations, rapid cycling, the number of previous mood episodes, age of first depressive episode, and age of first psychotic symptoms. Strong predictors of suicide attempts were younger age at onset, lifetime history of auditory hallucinations, and history of antidepressant use. Antecedent depressive episodes and psychotic symptoms predicted the first suicide attempt in patients with bipolar disorder. This study could help clinicians to understand the major risk factors of suicidal behavior in bipolar disorder. PMID:23124183

  6. Serotonergic Dysfunction in Patients with Bipolar Disorder Assessed by the Loudness Dependence of the Auditory Evoked Potential

    PubMed Central

    Lee, Kyung-Sang; Park, Young-Min

    2012-01-01

    Objective The loudness dependence of the auditory evoked potential (LDAEP) is suggested to be a marker of serotonin system function. This study explored the LDAEP of multiple mood statuses (depression, mania, and euthymia) and its clinical implication in bipolar disorder patients. Methods A total of 89 subjects, comprising 35 patients with bipolar disorder, 32 patients with schizophrenia, and 22 healthy controls were evaluated. The bipolar disorder cases comprised 10 depressed patients, 15 patients with mania, and 10 euthymic patients. The N1/P2 peak-to-peak amplitudes were measured at 5 stimulus intensities, and the LDAEP was calculated as the slope of the linear regression. Both cortical and source LDAEP values were calculated. Results LDAEP varied according to mood statuses, and was significantly stronger in cases of euthymia, depression, and mania. Cortical LDAEP was significantly stronger in patients with bipolar euthymia compared with schizophrenia, stronger in bipolar depression than in schizophrenia, stronger in healthy controls than in schizophrenia patients, and stronger in healthy controls than in patients with bipolar mania. Source LDAEP was significantly stronger in patients with bipolar euthymia, bipolar depression, and bipolar mania compared with schizophrenia, stronger in bipolar euthymia than in bipolar mania. Psychotic features weakened the source LDAEP relative to nonpsychotic features. The severity of the depressive symptom was negatively correlated with source LDAEP. Conclusion These findings suggest that the serotonin activity of patients with bipolar disorder may vary according to mood status. A longitudinal follow-up study should be pursued using drug-naive subjects. PMID:22993531

  7. Neurodegenerative changes in patients with clinical history of bipolar disorders.

    PubMed

    Shioya, Ayako; Saito, Yuko; Arima, Kunimasa; Kakuta, Yukio; Yuzuriha, Takefumi; Tanaka, Noriko; Murayama, Shigeo; Tamaoka, Akira

    2015-06-01

    Neurodegeneration in bipolar disorder (BPD) is poorly understood. Therefore, the current study was designed to assess the immunohistochemical changes in neurodegenerative markers in patients with BPD. Eleven consecutive autopsy cases diagnosed with BPD were analyzed. Sections were obtained from archival paraffin blocks of representative areas and stained using conventional methods, as well as immunostained with several antibodies to screen for neurodegenerative diseases. Age- and non-argyrophilic grains (AGs) degeneration matched controls were selected for each case. Clinical information was retrospectively collected from medical charts. All patients were men, and the average age of death was 70 years. Neuropathological diagnoses included dementia with grains (2), argyrophilic grain disease (2), corticobasal degeneration (CBD, 1), Lewy body disease (1), hypoxic encephalopathy (1) and cerebral infarction (1). All cases showed AGs to various degrees. Three patients died in their 50s; one demonstrated dementia with Lewy bodies, while the other two showed abundant AGs in the thalamus and amygdala. Of the three patients who died in their 60s, one showed AGs preferentially in the thalamus and amygdala, while the others demonstrated limbic predominance. The patients who died in/after their 70s demonstrated AGs similar to controls, except for the patient with CBD. Our data provides potentiality that neurodegenerative diseases may be an underlying pathology in certain cases of BPD. PMID:25819679

  8. Internet use by patients with bipolar disorder: Results from an international multisite survey.

    PubMed

    Bauer, Rita; Conell, Jörn; Glenn, Tasha; Alda, Martin; Ardau, Raffaella; Baune, Bernhard T; Berk, Michael; Bersudsky, Yuly; Bilderbeck, Amy; Bocchetta, Alberto; Bossini, Letizia; Castro, Angela M Paredes; Cheung, Eric Yw; Chillotti, Caterina; Choppin, Sabine; Del Zompo, Maria; Dias, Rodrigo; Dodd, Seetal; Duffy, Anne; Etain, Bruno; Fagiolini, Andrea; Hernandez, Miryam Fernández; Garnham, Julie; Geddes, John; Gildebro, Jonas; Gonzalez-Pinto, Ana; Goodwin, Guy M; Grof, Paul; Harima, Hirohiko; Hassel, Stefanie; Henry, Chantal; Hidalgo-Mazzei, Diego; Kapur, Vaisnvy; Kunigiri, Girish; Lafer, Beny; Larsen, Erik R; Lewitzka, Ute; Licht, Rasmus W; Lund, Anne Hvenegaard; Misiak, Blazej; Monteith, Scott; Munoz, Rodrigo; Nakanotani, Takako; Nielsen, René E; O'Donovan, Claire; Okamura, Yasushi; Osher, Yamima; Piotrowski, Patryk; Reif, Andreas; Ritter, Philipp; Rybakowski, Janusz K; Sagduyu, Kemal; Sawchuk, Brett; Schwartz, Elon; Scippa, Ângela M; Slaney, Claire; Sulaiman, Ahmad H; Suominen, Kirsi; Suwalska, Aleksandra; Tam, Peter; Tatebayashi, Yoshitaka; Tondo, Leonardo; Vieta, Eduard; Vinberg, Maj; Viswanath, Biju; Volkert, Julia; Zetin, Mark; Whybrow, Peter C; Bauer, Michael

    2016-08-30

    There is considerable international interest in online education of patients with bipolar disorder, yet little understanding of how patients use the Internet and other sources to seek information. 1171 patients with a diagnosis of bipolar disorder in 17 countries completed a paper-based, anonymous survey. 81% of the patients used the Internet, a percentage similar to the general public. Older age, less education, and challenges in country telecommunications infrastructure and demographics decreased the odds of using the Internet. About 78% of the Internet users looked online for information on bipolar disorder or 63% of the total sample. More years of education in relation to the country mean, and feeling very confident about managing life decreased the odds of seeking information on bipolar disorder online, while having attended support groups increased the odds. Patients who looked online for information on bipolar disorder consulted medical professionals plus a mean of 2.3 other information sources such as books, physician handouts, and others with bipolar disorder. Patients not using the Internet consulted medical professionals plus a mean of 1.6 other information sources. The percentage of patients with bipolar disorder who use the Internet is about the same as the general public. Other information sources remain important. PMID:27391371

  9. Comparison of the haemostatic properties of conventional monopolar and bipolar transurethral resection of the prostate in patients on oral anticoagulants

    PubMed Central

    Michielsen, Dirk P.J.; Coomans, Danny; Van Lersberghe, Caroline; Braeckman, Johan G.

    2011-01-01

    Introduction The aim of study is comparing the haemostatic properties of conventional monopolar resection (TURP) and bipolar transurethral resection in saline (TURIS) of the prostate in patients under chronic oral anticoagulants. Material and methods Out of a cohort group of 550 endoscopic resections for bladder outlet obstruction, 176 patients on chronic oral anticoagulant therapy required endoscopic resection either by monopolar TURP or bipolar TURIS technology. Changes in haemoglobin, blood transfusion, and clot retention were compared between both groups. Results Mean postoperative change in haemoglobin level was –1.21 ±0.92 mg/dl in the TURP group compared to –1.29 ±0.99 mg/dl in the TURIS group (p = 0.603). The need for blood transfusions and the mean numbers of units transfused did not significantly differ between the 2 groups. Clot retention appeared in 12 patients (15%) in the TURP group compared to 13 patients (13%) in the TURIS group (p = 0.828). Conclusions Despite promising experimental results of better haemostasis and deeper coagulation depth, bipolar technology does not permit one to reduce the amount of blood loss when compared to patients treated by conventional monopolar technology in this study group of patients on oral anticoagulation therapy. Patients on oral anticoagulants suffer more incidents of clot retention, which sometimes results in re-hospitalisation. PMID:22291832

  10. Differential responses to lithium in hyperexcitable neurons from patients with bipolar disorder.

    PubMed

    Mertens, Jerome; Wang, Qiu-Wen; Kim, Yongsung; Yu, Diana X; Pham, Son; Yang, Bo; Zheng, Yi; Diffenderfer, Kenneth E; Zhang, Jian; Soltani, Sheila; Eames, Tameji; Schafer, Simon T; Boyer, Leah; Marchetto, Maria C; Nurnberger, John I; Calabrese, Joseph R; Ødegaard, Ketil J; McCarthy, Michael J; Zandi, Peter P; Alda, Martin; Alba, Martin; Nievergelt, Caroline M; Mi, Shuangli; Brennand, Kristen J; Kelsoe, John R; Gage, Fred H; Yao, Jun

    2015-11-01

    Bipolar disorder is a complex neuropsychiatric disorder that is characterized by intermittent episodes of mania and depression; without treatment, 15% of patients commit suicide. Hence, it has been ranked by the World Health Organization as a top disorder of morbidity and lost productivity. Previous neuropathological studies have revealed a series of alterations in the brains of patients with bipolar disorder or animal models, such as reduced glial cell number in the prefrontal cortex of patients, upregulated activities of the protein kinase A and C pathways and changes in neurotransmission. However, the roles and causation of these changes in bipolar disorder have been too complex to exactly determine the pathology of the disease. Furthermore, although some patients show remarkable improvement with lithium treatment for yet unknown reasons, others are refractory to lithium treatment. Therefore, developing an accurate and powerful biological model for bipolar disorder has been a challenge. The introduction of induced pluripotent stem-cell (iPSC) technology has provided a new approach. Here we have developed an iPSC model for human bipolar disorder and investigated the cellular phenotypes of hippocampal dentate gyrus-like neurons derived from iPSCs of patients with bipolar disorder. Guided by RNA sequencing expression profiling, we have detected mitochondrial abnormalities in young neurons from patients with bipolar disorder by using mitochondrial assays; in addition, using both patch-clamp recording and somatic Ca(2+) imaging, we have observed hyperactive action-potential firing. This hyperexcitability phenotype of young neurons in bipolar disorder was selectively reversed by lithium treatment only in neurons derived from patients who also responded to lithium treatment. Therefore, hyperexcitability is one early endophenotype of bipolar disorder, and our model of iPSCs in this disease might be useful in developing new therapies and drugs aimed at its clinical

  11. Quality of life among patients with bipolar disorder in primary care versus community mental health settings

    PubMed Central

    Miller, Christopher J.; Abraham, Kristen M.; Bajor, Laura A.; Lai, Zongshan; Kim, Hyungjin Myra; Nord, Kristina M.; Goodrich, David E.; Bauer, Mark S.; Kilbourne, Amy M.

    2012-01-01

    Introduction Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder. Methods HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) health scales. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse. Results A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p = .98 and p = .49, respectively). Depressive symptoms were associated with lower MCS scores (B = −.68, p < .001) while arthritis/chronic pain was strongly related to lower PCS scores (B = −5.23, p < .001). Limitations This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states. Discussion Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment. PMID:22981021

  12. Altered Functional Connectivity between Emotional and Cognitive Resting State Networks in Euthymic Bipolar I Disorder Patients

    PubMed Central

    Lois, Giannis; Linke, Julia; Wessa, Michèle

    2014-01-01

    Bipolar disorder is characterized by a functional imbalance between hyperactive ventral/limbic areas and hypoactive dorsal/cognitive brain regions potentially contributing to affective and cognitive symptoms. Resting-state studies in bipolar disorder have identified abnormal functional connectivity between these brain regions. However, most of these studies used a seed-based approach, thus restricting the number of regions that were analyzed. Using data-driven approaches, researchers identified resting state networks whose spatial maps overlap with frontolimbic areas such as the default mode network, the frontoparietal networks, the salient network, and the meso/paralimbic network. These networks are specifically engaged during affective and cognitive tasks and preliminary evidence suggests that functional connectivity within and between some of these networks is impaired in bipolar disorder. The present study used independent component analysis and functional network connectivity approaches to investigate functional connectivity within and between these resting state networks in bipolar disorder. We compared 30 euthymic bipolar I disorder patients and 35 age- and gender-matched healthy controls. Inter-network connectivity analysis revealed increased functional connectivity between the meso/paralimbic and the right frontoparietal network in bipolar disorder. This abnormal connectivity pattern did not correlate with variables related to the clinical course of the disease. The present finding may reflect abnormal integration of affective and cognitive information in ventral-emotional and dorsal-cognitive networks in euthymic bipolar patients. Furthermore, the results provide novel insights into the role of the meso/paralimbic network in bipolar disorder. PMID:25343370

  13. Differential Neurodevelopmental Trajectories in Patients With Early-Onset Bipolar and Schizophrenia Disorders

    PubMed Central

    Arango, Celso

    2014-01-01

    Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders. PMID:24371326

  14. Differential neurodevelopmental trajectories in patients with early-onset bipolar and schizophrenia disorders.

    PubMed

    Arango, Celso; Fraguas, David; Parellada, Mara

    2014-03-01

    Schizophrenia and bipolar disorders share not only clinical features but also some risk factors such as genetic markers and childhood adversity, while other risk factors such as urbanicity and obstetric complications seem to be specific to schizophrenia. An intriguing question is whether the well-established abnormal neurodevelopment present in many children and adolescents who eventually develop schizophrenia is also present in bipolar patients. The literature on adult bipolar patients is controversial. We report data on a subgroup of patients with pediatric-onset psychotic bipolar disorder who seem to share some developmental trajectories with patients with early-onset schizophrenia. These early-onset psychotic bipolar patients have low intelligence quotient, more neurological signs, reduced frontal gray matter at the time of their first psychotic episode, and greater brain changes than healthy controls in a pattern similar to early-onset schizophrenia cases. However, patients with early-onset schizophrenia seem to have more social impairment, developmental abnormalities (eg, language problems), and lower academic achievement in childhood than early-onset bipolar patients. We suggest that some of these abnormal developmental trajectories are more related to the phenotypic features (eg, early-onset psychotic symptoms) of these 2 syndromes than to categorically defined Diagnostic and Statistical Manual of Mental Disorders disorders. PMID:24371326

  15. Neurological soft signs in euthymic bipolar I patients: A comparative study with healthy siblings and controls.

    PubMed

    Mrad, Amel; Wassim Krir, Mohamed; Ajmi, Inès; Gaha, Lotfi; Mechri, Anwar

    2016-02-28

    Neurological Soft Signs (NSS) are endophenotypic markers widely studied in schizophrenia and remain poorly evaluated in bipolar disorder. The aims of this paper were to determine the prevalence and scores of NSS in bipolar I patients, compared to healthy siblings and controls and to explore correlations with socio-demographic and clinical features of patients. This was a case-control study comparing 92 euthymic bipolar I patients, 44 of their healthy siblings and 60 control subjects. The neurological assessment was performed through the NSS scale validated by Krebs et al. (2000). Bipolar I patients were also assessed with the Bech-Rafaelsen Mania Scale (MAS), the Hamilton Depression Rating Scale (HDRS) and the Global Assessment of Functioning (GAF). The raters were not blinded to groups. The prevalence and the total score of NSS were significantly higher in bipolar I patients compared to their healthy siblings and controls. The sibling group had significantly higher NSS prevalence and total score than controls. No correlation was found between NSS total score and socio-demographic and clinical features of patients, except a negative correlation with the school level and the GAF score. In conclusion, bipolar I patients have motor and sensory signs, which are unrelated to their clinical features. PMID:26775167

  16. Informational needs of patients hospitalized for bipolar disorder.

    PubMed

    Pollack, L E

    1995-11-01

    Thirty-three inpatients (20 women and 13 men) with bipolar disorder participated in audiotaped, semi-structured interviews that focused on their informational needs in six areas: self-management of the disorder, understanding bipolar disorder, managing daily life, living in society, relating to others, and relating to self. The interviews were transcribed and systematically analyzed to produce a typology of needs, which was evaluated by the interviewees as it evolved. The typology is useful for structuring psychoeducational programs. The findings attest to the importance of providing education for persons with bipolar disorder in all health care settings in which they seek treatment. PMID:8564512

  17. Deficits in docosahexaenoic acid and associated elevations in the metabolism of arachidonic acid and saturated fatty acids in the postmortem orbitofrontal cortex of patients with bipolar disorder.

    PubMed

    McNamara, Robert K; Jandacek, Ronald; Rider, Therese; Tso, Patrick; Stanford, Kevin E; Hahn, Chang-Gyu; Richtand, Neil M

    2008-09-30

    Previous antemortem and postmortem tissue fatty acid composition studies have observed significant deficits in the omega-3 fatty acid docosahexaenoic acid (DHA, 22:6n-3) in red blood cell (RBC) and postmortem cortical membranes of patients with unipolar depression. In the present study, we determined the fatty acid composition of postmortem orbitofrontal cortex (OFC, Brodmann area 10) of patients with bipolar disorder (n=18) and age-matched normal controls (n=19) by gas chromatography. After correction for multiple comparisons, DHA (-24%), arachidonic acid (-14%), and stearic acid (C18:0) (-4.5%) compositions were significantly lower, and cis-vaccenic acid (18:1n-7) (+12.5%) composition significantly higher, in the OFC of bipolar patients relative to normal controls. Based on metabolite:precursor ratios, significant elevations in arachidonic acid, stearic acid, and palmitic acid conversion/metabolism were observed in the OFC of bipolar patients, and were inversely correlated with DHA composition. Deficits in OFC DHA and arachidonic acid composition, and elevations in arachidonic acid metabolism, were numerically (but not significantly) greater in drug-free bipolar patients relative to patients treated with mood-stabilizer or antipsychotic medications. OFC DHA and arachidonic acid deficits were greater in patients plus normal controls with high vs. low alcohol abuse severity. These results add to a growing body of evidence implicating omega-3 fatty acid deficiency as well as the OFC in the pathoaetiology of bipolar disorder. PMID:18715653

  18. Role of Behavioral Addictions in Predicting Reactivity in Bipolar Mood Disorder Patients

    PubMed Central

    Abolghasemi, Abbas; Sadeghi, Hasan; Kiamarsi, Azar; Abbasi, Moslem

    2014-01-01

    Background: Behavioral addictions (BAs) can be understood as disorders characterized by repetitive occurrence of reactivity and uncontrolled behaviors. Very few studies have investigated their association with bipolar mood disorders. Objectives: The present study aimed to determine the role of behavioral addictions in predicting interpersonal behavioral addictions in bipolar mood disorder patients. Materials and Methods: This study had a cross-sectional correlation design. The statistical population was composed of all outpatients with bipolar mood disorders referring to clinical centers in Ardabil. The sample included 60 bipolar mood patients selected from patients referring to clinical centers using the available sampling method. A researcher-made behavioral addiction checklist, Interpersonal Behavioral Addictions Index, and exercise, sexual, and work addiction questionnaires, were used for data collection. The data were analyzed with a Pearson’s correlation coefficient and multivariate regression analysis. Results: The results showed a significant negative relationship between behavioral addictions and interpersonal behavioral addictions (P ≥ 0.01). Multivariate regression analysis results also showed that behavioral addictions are significant and can explain 61% of the variance of interpersonal behavioral addictions in bipolar mood patients. Conclusions: These results suggest that addictive behaviors can affect behavioral addictions in bipolar mood patients. Behavioral addictions lead to negative emotional regulation strategies and result in increased behavioral addictions in these patients. People with high levels of arousal or those who cannot control their behavioral addictions are probably more prone to addictive behaviors. PMID:24971298

  19. Influence of valproate on the required dose of propofol for anesthesia during electroconvulsive therapy of bipolar affective disorder patients

    PubMed Central

    Hızlı Sayar, Gökben; Eryılmaz, Gül; Şemieoğlu, Siban; Özten, Eylem; Göğcegöz Gül, Işıl

    2014-01-01

    Background Propofol is often used as an anesthetic agent for electroconvulsive therapy (ECT). In recent studies, propofol was shown to possess significant seizure-shortening properties during ECT. “Valproate” is a mood stabilizer used mainly in the treatment of bipolar affective disorder. It is reported that valproate, being an anticonvulsant, raises the seizure threshold, thus decreases the efficacy of ECT treatment. Aim The purpose of our study was to compare the dose of propofol in valproate-using patients and valproate-free patients. Methods In an open design, 17 patients with bipolar affective disorder manic episodes who were to be treated with valproate and ECT in combination, were compared with 16 manic-episode patients who were to be treated with ECT but not valproate. The two groups were compared on the basis of electroencephalography-registered seizure duration and the propofol dosage required to induce anesthesia. Results Valproate, compared with no valproate treatment, results in a decrease in the propofol dose required to induce anesthesia. In the valproate group of study participants, seizure duration was significantly shorter than in the valproate-free group. Conclusion The results suggest that valproate reduces the dose of propofol required for anesthesia during ECT treatment in patients with bipolar affective disorder manic episodes. Although propofol is a safe and efficacious anesthetic for ECT treatment, lower doses of propofol should be used to induce anesthesia for patients under valproate treatment. When the clinician needs to prolong seizure duration in patients treated with valproate, interruption of the valproate treatment or an anesthetic agent other than propofol should be considered. PMID:24623978

  20. Category fluency performance in patients with schizophrenia and bipolar disorder: The influence of affective categories.

    PubMed

    Rossell, Susan L

    2006-02-28

    Semantic fluency (SF) and phonological fluency (PF) were examined in large groups of schizophrenia patients, bipolar patients and controls. As well as standard SF categories (animals and food), fluency to two affective categories, happy and fear was measured, i.e. participants were asked to produce as many words as they could that resulted in or are associated with fear or happiness. Schizophrenia patients showed SF and PF deficits. Bipolar patients showed PF deficits. Thus, PF is argued to be a good cognitive marker in both disorders. Severity of delusions was related to SF performance in all patients. The patient groups showed different patterns on the affective categories compared to controls: the bipolar patients were better and produced more words, especially to the happiness category, and the schizophrenia patients were impaired and produced less words. The results suggest an interesting interaction between psychotic illnesses, fluency and emotion. PMID:16376054

  1. Risk or resilience? Empathic abilities in patients with bipolar disorders and their first-degree relatives.

    PubMed

    Seidel, Eva-Maria; Habel, Ute; Finkelmeyer, Andreas; Hasmann, Alexander; Dobmeier, Matthias; Derntl, Birgit

    2012-03-01

    Endophenotypes are intermediate phenotypes which are considered a more promising marker of genetic risk than illness itself. While previous research mostly used cognitive deficits, emotional functions are of greater relevance for bipolar disorder regarding the characteristic emotional hyper-reactability and deficient social-emotional competence. Hence, the aim of the present study was to clarify whether empathic abilities can serve as a possible endophenotype of bipolar disorder by applying a newly developed task in bipolar patients and their first-degree relatives. Three components of empathy (emotion recognition, perspective taking and affective responsiveness) have been assessed in a sample of 21 bipolar patients, 21 first-degree relatives and 21 healthy controls. Data analysis indicated significant differences between controls and patients for emotion recognition and affective responsiveness but not for perspective taking. This shows that in addition to difficulties in recognizing facial emotional expressions, bipolar patients have difficulties in identifying emotions they would experience in a given situation. However, the ability to take the perspective of another person in an emotional situation was intact but decreased with increasing severity of residual hypomanic and depressive symptoms. Relatives performed comparably bad on emotion recognition but did not differ from controls or patients in affective responsiveness. This study is the first to show that deficient emotion recognition is the only component of empathy which forms a possible endophenotype of bipolar disorder. This has important implications for prevention strategies. Furthermore, changes in affective responsiveness in first-degree relatives show a potential resilience marker. PMID:22133461

  2. Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study

    PubMed Central

    Lundgren, Maria; Brandt, Lena; Reutfors, Johan; Andersen, Morten; Kieler, Helle

    2012-01-01

    Objective To investigate the risks of adverse pregnancy and birth outcomes for treated and untreated bipolar disorder during pregnancy. Design Population based cohort study using data from national health registers. Setting Sweden. Participants 332 137 women with a last menstrual period anytime after 1 July 2005 and giving birth anytime before the end of 31 December 2009. Women with a record of at least two bipolar diagnoses were identified and grouped as treated (n=320)—those who had filled a prescription for mood stabilisers (lithium, antipsychotics, or anticonvulsants) during pregnancy—or untreated (n=554). Both groups were compared with all other women giving birth (n=331 263). Main outcome measures Preterm birth, mode of labour initiation, gestational diabetes, infants born small or large for gestational age, neonatal morbidity, and congenital malformations. Results Of the untreated women, 30.9% (n=171) were induced or had a planned caesarean delivery compared with 20.7% (n=68 533) without bipolar disorder (odds ratio 1.57, 95% confidence interval 1.30 to 1.90). The corresponding values for the treated women were 37.5% (n=120) (2.12, 1.68 to 2.67). The risks of preterm birth in both treated and untreated women were increased by 50%. Of the untreated women, 3.9% (n=542) had a microcephalic infant compared with 2.3% (324 844) of the women without bipolar disorder (1.68, 1.07 to 2.62). The corresponding values for the treated women were 3.3% (n=311) (1.26, 0.67 to 2.37). Similar trends were observed for risks of infants being small for gestational age infants for weight and length. Among infants of untreated women, 4.3% (n=24) had neonatal hypoglycaemia compared with 2.5% (n=8302) among infants of women without bipolar disorder (1.51, 1.04 to 2.43), and 3.4% (n=11) of the treated women (1.18, 0.64 to 2.16). The analyses of variation in outcomes did not support any significant differences between treated and untreated women. Conclusions Bipolar

  3. Adherence to Antipsychotic Medication in Bipolar Disorder and Schizophrenic Patients: A Systematic Review.

    PubMed

    García, Saínza; Martínez-Cengotitabengoa, Mónica; López-Zurbano, Saioa; Zorrilla, Iñaki; López, Purificación; Vieta, Eduard; González-Pinto, Ana

    2016-08-01

    Antipsychotics are the drugs prescribed to treat psychotic disorders; however, patients often fail to adhere to their treatment, and this has a severe negative effect on prognosis in these kinds of illnesses. Among the wide range of risk factors for treatment nonadherence, this systematic review covers those that are most important from the point of view of clinicians and patients and proposes guidelines for addressing them. Analyzing 38 studies conducted in a total of 51,796 patients, including patients with schizophrenia spectrum disorders and bipolar disorder, we found that younger age, substance abuse, poor insight, cognitive impairments, low level of education, minority ethnicity, poor therapeutic alliance, experience of barriers to care, high intensity of delusional symptoms and suspiciousness, and low socioeconomic status are the main risk factors for medication nonadherence in both types of disorder. In the future, prospective studies should be conducted on the use of personalized patient-tailored treatments, taking into account risk factors that may affect each individual, to assess the ability of such approaches to improve adherence and hence prognosis in these patients. PMID:27307187

  4. Medication Adherence in Patients with Bipolar Disorder: A Comprehensive Review.

    PubMed

    Levin, Jennifer B; Krivenko, Anna; Howland, Molly; Schlachet, Rebecca; Sajatovic, Martha

    2016-09-01

    Poor medication adherence is a pervasive problem that causes disability and suffering as well as extensive financial costs among individuals with bipolar disorder (BD). Barriers to adherence are numerous and cross multiple levels, including factors related to bipolar pathology and those unique to an individual's circumstances. External factors, including treatment setting, healthcare system, and broader health policies, can also affect medication adherence in people with BD. Fortunately, advances in research have suggested avenues for improving adherence. A comprehensive review of adherence-enhancement interventions for the years 2005-2015 is included. Specific bipolar adherence-enhancement approaches that target knowledge gaps, cognitive patterns, specific barriers, and motivation may be helpful, as may approaches that capitalize on technology or novel drug-delivery systems. However, much work remains to optimally facilitate long-term medication adherence in people with BD. For adherence-enhancement approaches to be widely adapted, they need to be easily accessible, affordable, and practical. PMID:27435356

  5. Current Suicide Ideation and Prior Suicide Attempts of Bipolar Patients as Influences on Caregiver Burden

    ERIC Educational Resources Information Center

    Chessick, Cheryl A.; Perlick, Deborah A.; Miklowitz, David J.; Kaczynski, Richard; Allen, Michael H.; Morris, Chad D.; Marangell, Lauren B.

    2007-01-01

    We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal…

  6. Contributors to Suicidal Ideation among Bipolar Patients with and without a History of Suicide Attempts

    ERIC Educational Resources Information Center

    Allen, Michael H.; Chessick, Cheryl A.; Miklowitz, David J.; Goldberg, Joseph F.; Wisniewski, Stephen R.; Miyahara, Sachiko; Calabrese, Joseph R.; Marangell, Lauren; Bauer, Mark S.; Thomas, Marshall R.; Bowden, Charles L.; Sachs, Gary S.

    2005-01-01

    This study was designed to develop models for vulnerability to suicidal ideation in bipolar patients. Logistic regression models examined correlates of suicidal ideation in patients who had versus had not attempted suicide previously. Of 477 patients assessed, complete data on demographic, illness history, and personality variables were available…

  7. Bipolar Disorder and Cognitive Therapy: A Commentary

    ERIC Educational Resources Information Center

    Riskind, John H.

    2005-01-01

    This article comments on the three articles (Leahy, 2005; Newman, 2005; and Reilly-Harrington & Knauz, 2005) that deal with the applications of cognitive therapy to treatment of bipolar disorder. They focus on the uses of cognitive therapy in treating three important facets of the special problems of bipolar patients: rapid cycling, severe…

  8. Patients with bipolar disorder show differential executive dysfunctions: A case-control study.

    PubMed

    Leung, Meranda M W; Lui, Simon S Y; Wang, Ya; Tsui, Chi F; Au, Angie C W; Yeung, Hera K H; Yang, Tian-Xiao; Li, Zhi; Cheng, Chi-Wai; Cheung, Eric F C; Chan, Raymond C K

    2016-04-30

    Executive deficits in euthymic bipolar I disorder were examined in a fractionated manner based on the "Supervisory Attentional System" (SAS) model, and the relationship between the degree of executive impairment and the demographic and clinical characteristics of bipolar I participants was explored. A battery of neurocognitive tests capturing specific components of executive function was administered on 30 patients with bipolar I disorder in euthymic state, and compared with 30 healthy controls who were matched by age, gender and IQ. A differential impairment in executive function was demonstrated in euthymic bipolar I participants by using a fractionated approach of the SAS. Euthymic bipolar I patients were found to have significantly poorer performance in immediate and delayed visual memory; and in the executive domains of "initiation", "sustained attention", and "attention allocation and planning". Those with a greater number of executive impairments had lower IQ and higher negative sub-scores on PANSS. These findings might provide a the basis for further studies on identifying the executive components that are associated with particular disease characteristics of bipolar disorder, and those with poorer functional outcome, so that rehabilitation can be focused on the selective domains concerned. PMID:27086222

  9. Clinical and Radiologic Outcomes among Bipolar Hemiarthroplasty, Compression Hip Screw and Proximal Femur Nail Antirotation in Treating Comminuted Intertrochanteric Fractures

    PubMed Central

    Suh, You-Sung; Nho, Jae-Hwi; Kim, Seong-Min; Hong, Sijohn; Choi, Hyung-Suk

    2015-01-01

    Purpose In comminuted intertrochanteric fractures, various operative options have been introduced. The purpose of this study was to determine whether there were differences in clinical and radiologic outcomes among bipolar hemiarthroplasty (BH), compression hip screw (CHS) and proximal femur nail antirotation (PFNA) in treating comminuted intertrochanteric fractures (AO/OTA classification, A2 [22, 23]) Materials and Methods We retrospectively evaluated total 150 patients (BH, 50; CHS, 50; PFNA, 50) who were operated due to intertrochanteric fractures from March 2010 to December 2012 and were older than 65 years at the time of surgery. We compared these three groups for radiologic and clinical outcomes at 12 months postoperatively, including Harris Hip Score, mobility (Koval stage), visual analogue scale and radiologic limb length discrepancy (shortening). Results There was no statistical significance among three groups in clinical outcomes including Harris Hip Score, mobility (Koval stage), visual analogue scale. However, there was significant differences in radiologic limb discrepancy in plain radiographs at 12 months postoperatively (radiologic shortening: BH, 2.3 mm; CHS, 5.1 mm; PFNA, 3.0 mm; P=0.000). Conclusion There were no clinical differences among BH, PFNA, and CHS in this study. However, notable limb length shortening could be originated during fracture healing in osteosynthesis, compared to arthroplasty (BH

  10. Undiagnosed Bipolar Disorders in Patients with Major Depressive Episode: Iran's part of a Multicenter Cross-Sectional Study

    PubMed Central

    Sadeghi, Majid; Ardestani, Seyed Mehdi Samimi; Semnani, Yousef; Mirsepassi, Gholamreza; Sadr, Seyed Saeed; Kamaloo, Atefe; Ahadi, Morvarid; Pourmirza, Behin; Mir, Elham

    2013-01-01

    Objective Bipolar spectrum disorders may often go undiagnosed or unrecognized. The aim of this study was to determine the proportion of bipolar disorder symptoms in Iranian patients with a major depressive episode. Methods 313 patients with a current DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders 4th ed. Text rev.) diagnosed with a major depressive episode entered this cross-sectional study. Thirty two items revised Hypomania/ mania Symptoms Checklist (HCL-32) was used to determine the frequency of bipolar episodes. Results Considerable proportion of patients (53.9%) previously diagnosed as major depressive disorder fulfilled the criteria for bipolar disorder by Bipolarity Specifier. The Bipolarity Specifier additionally identified significant association for manic / hypomanic states during antidepressants therapy (p<0.0003) and current mixed mood symptoms (p<0.0001) Conclusion Bipolar symptoms meeting the criteria for bipolar disorders in depressed patients who have not been previously diagnosed with bipolar disorder are frequent. Current DSM criteria may not be sufficient to diagnose more subtle or atypical forms of bipolar disorders. PMID:23682245

  11. A Case of Clozapine-Induced Myocarditis in a Young Patient with Bipolar Disorder

    PubMed Central

    Cohen, Ronny; Lysenko, Alla; Mallet, Thierry; Mirrer, Brooks; Gale, Michael; Loarte, Pablo; McCue, Robert

    2015-01-01

    We present a case of drug-induced myocarditis manifesting as acute heart failure in a young patient with bipolar disorder being treated for depression. The case describes a 20-year-old man being treated in the psychiatry ward for worsening depression when he started complaining of chest pain and shortness of breath. His list of medications included clozapine, lithium, lorazepam, and haloperidol. The main findings on physical examination were tachycardia, low-grade fever, crackles in both lung bases on auscultation, and the absence of any notable edema. Abnormal labs included a troponin of 0.9, with a CK of 245 and CK-MB of 3.1. An ECG revealed sinus tachycardia and left anterior fascicular block (LAFB). An echocardiogram revealed global hypokinesis, severe left ventricular dysfunction with an ejection fraction estimated at 20%. The patient had an admitting diagnosis of acute left ventricular systolic dysfunction likely secondary to drug-induced myocarditis (suspect clozapine) versus acute coronary syndrome. He was managed conservatively and transferred to another facility for endomyocardial biopsy confirming myocarditis. This case is an example of one of the most typical presentations of suspected drug-induced acute myocarditis and will hopefully prompt the reader to think of this underdiagnosed entity in the right clinical setting. PMID:26413355

  12. Genetic variations within Metalloproteinases impact on the prophylaxis of depressive phases in Bipolar Patients

    PubMed Central

    Drago, Antonio; Monti, Barbara; De Ronchi, Diana; Serretti, Alessandro

    2014-01-01

    Background The genetic background of antidepressant response to pharmacological treatment in Bipolar Disorder (BD) remains elusive. This issue is of primary relevance in that the depressive phases of BD are difficult to treat and they are associated with suicide. Aim We investigated the role of a set of genetic variations (SNPs) harbored by metalloproteinases (MPPs) as predictors of response to treatment in depressed BD patients. Methods 654 BD patients from the public available STEP-BD study were investigated. Outcome was the number of depressive events corrected by the number of times patients were assessed. Clinical and sociodemographic variables were tested as possible stratification factors and included in the analysis if necessary. Genetic predictors were 43 SNPs harbored by 17 MPPs. Imputation, quality check and pruning were conducted according to standards. Results were corrected for multitesting. Results rs486055 (MMP-10) was associated with the outcome. TT homozygotes had 5.08±3.51 events, CT had 3.47±3.18 and CC had 2.57±2.96 depressive events corrected for the times they have been assessed. The time during which BD patients were observed was not significantly different between the rs486055 genotypes. We found evidence that MMP-10 may be a mediator of the number of depressive phases during BD. Due to the limits of the study including the small-medium sample size, the naturalistic design and the possible occurrence of false positive findings, independent analyses are warranted. PMID:24576976

  13. Subjective Symptoms in Euthymic Bipolar Disorder and Remitted Schizophrenia Patients: A Comparative Study

    PubMed Central

    Kumar, Manish; Sinha, Vinod Kumar; Mondal, Anwesha

    2016-01-01

    Background: Subjective experience means subtle, not yet psychotic abnormalities of experience that might be present during remitted phase and also in prodromal phase of schizophrenia and might be accurately efficient in identifying individuals at risk of eminent psychosis (Parnas et al., 2003). Apart from schizophrenic patients, bipolar patients also experience certain subjective symptoms in their euthymic state. They often experience subtle cognitive impairment and functional disturbances during their euthymic states. These subjective experiences may be related to distorted cognitive functions in these patients. These experiences include a great variety of cognitive dysfunction complaints about attention, perception, memory, thinking, language, movement, and emotion. Objective: To measure the experience of subjective symptoms and compare them between euthymic bipolar and remitted schizophrenia patients. Materials and Methods: Thirty euthymic bipolar patients and 30 remitted schizophrenia patients as per International Classification of Diseases Tenth Revision were selected for the purpose of the study. At first, sociodemographic data were collected. And then, the patients were assessed using the scales; positive and negative syndrome scale, Young Mania Rating Scale, Hamilton Depression Rating Scale, Symptom Checklist-90-Revised, and Frankfurt Complaint Questionnaire-24. Results: Both the groups showed significant differences in terms of subjective symptoms. However, no significant correlation has been found between the objective psychopathology and subjective experience in the two groups. Conclusion: It can be suggested that the patients with schizophrenia show significantly higher subjective experience when compared with the patients of bipolar disorder. PMID:27114621

  14. Structural and Functional Brain Correlates of Cognitive Impairment in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Goikolea, José M.; Bonnin, Caterina M.; Sarró, Salvador; Segura, Barbara; Amann, Benedikt L.; Monté, Gemma C.; Moro, Noemi; Fernandez-Corcuera, Paloma; Maristany, Teresa; Salvador, Raymond; Vieta, Eduard; Pomarol-Clotet, Edith; McKenna, Peter J.

    2016-01-01

    Introduction Cognitive impairment in the euthymic phase is a well-established finding in bipolar disorder. However, its brain structural and/or functional correlates are uncertain. Methods Thirty-three euthymic bipolar patients with preserved memory and executive function and 28 euthymic bipolar patients with significant memory and/or executive impairment, as defined using two test batteries, the Rivermead Behavioural Memory Test (RBMT) and the Behavioural Assessment of the Dysexecutive Syndrome (BADS), plus 28 healthy controls underwent structural MRI using voxel-based morphometry (VBM). Twenty-seven of the cognitively preserved patients, 23 of the cognitively impaired patients and 28 controls also underwent fMRI during performance of the n-back working memory task. Results No clusters of grey or white matter volume difference were found between the two patient groups. During n-back performance, the cognitively impaired patients showed hypoactivation compared to the cognitively preserved patients in a circumscribed region in the right dorsolateral prefrontal cortex. Both patient groups showed failure of de-activation in the medial frontal cortex compared to the healthy controls. Conclusions Cognitive impairment in euthymic bipolar patients appears from this study to be unrelated to structural brain abnormality, but there was some evidence for an association with altered prefrontal function. PMID:27448153

  15. Light therapy in the treatment of patients with bipolar depression: A meta-analytic study.

    PubMed

    Tseng, Ping-Tao; Chen, Yen-Wen; Tu, Kun-Yu; Chung, Weilun; Wang, Hung-Yu; Wu, Ching-Kuan; Lin, Pao-Yen

    2016-06-01

    Light therapy (LT) has been widely used in the treatment of seasonal affective disorder. Recently some evidence indicated that LT may play a role in bipolar depression, either as monotherapy or in combination with total sleep deprivation (TSD). However, the studies examining the treatment effect of LT in bipolar depression resulted in inconsistent findings. To clarify the role of LT in the disorder, we conducted a meta-analysis to compare the efficacy of LT in the treatment of bipolar depression. The results of individual studies were synthesized by a random effects model. Nine studies including 489 patients with bipolar depression were included in this current meta-analysis. We found that disease severity was significantly decreased after LT, in both with and without TSD, and with concomitant medication (p<0.001). Augmentation treatment with LT significantly decreased disease severity compared to treatment without LT (p=0.024). Our results highlight the significant efficacy of LT, either as monotherapy or in combination with TSD, in the treatment of bipolar depression. However, the detailed mechanism of LT still remains elusive. Further well-designed controlled trials are required to investigate the optimal intensity and frequency of LT in the treatment of bipolar depression. PMID:26993616

  16. Cognitive Dysfunction Is Worse among Pediatric Patients with Bipolar Disorder Type I than Type II

    ERIC Educational Resources Information Center

    Schenkel, Lindsay S.; West, Amy E.; Jacobs, Rachel; Sweeney, John A.; Pavuluri, Mani N.

    2012-01-01

    Background: Impaired profiles of neurocognitive function have been consistently demonstrated among pediatric patients with bipolar disorder (BD), and may aid in the identification of endophenotypes across subtypes of the disorder. This study aims to determine phenotypic cognitive profiles of patients with BD Type I and II. Methods: Subjects (N =…

  17. Reducing the Risk of Suicide in Patients with Bipolar Disorder: Interventions and Safeguards

    ERIC Educational Resources Information Center

    Newman, Cory F.

    2005-01-01

    Bipolar disorder exacts a terrible toll on its sufferers owing to the repeated, severe disruptions in the patients' lives, the discomfort and uncertainties of being on rigorous, ongoing pharmacotherapy regimens, the emotional difficulties inherent in experiencing depression and mania, and the fear of a deteriorating course. Patients with bipolar…

  18. Neuropsychological performance and affective temperaments in Euthymic patients with bipolar disorder type II.

    PubMed

    Romero, Ester; Holtzman, Jessica N; Tannenhaus, Lucila; Monchablon, Romina; Rago, Carlo Mario; Lolich, Maria; Vázquez, Gustavo H

    2016-04-30

    Affective temperament has been suggested as a potential mediator of the effect between genetic predisposition and neurocognitive functioning. As such, this report seeks to assess the extent of the correlation between affective temperament and cognitive function in a group of bipolar II subjects. 46 bipolar II outpatients [mean age 41.4 years (SD 18.2); female 58.9%] and 46 healthy controls [mean age 35.1 years (SD 18); female 56.5%] were evaluated with regard to their demographic and clinical characteristics, affective temperament, and neurocognitive performance. Crude bivariate correlation analyses and multiple linear regression models were constructed between five affective temperament subscales and eight neurocognitive domains. Significant correlations were identified in bipolar patients between hyperthymic temperament and verbal memory and premorbid IQ; cyclothymic temperament and attention; and irritable temperament, attention, and verbal fluency. In adjusting for potential confounders of the relationship between temperament and cognitive function, the strongest mediating factors among the euthymic bipolar patients were found to be residual manic and depressive symptoms. It is therefore concluded that affective temperaments may partially influence the neurocognitive performance of both healthy controls and euthymic patients with bipolar disorder type II in several specific domains. PMID:27086230

  19. How specific are emotional deficits? A comparison of empathic abilities in schizophrenia, bipolar and depressed patients.

    PubMed

    Derntl, Birgit; Seidel, Eva-Maria; Schneider, Frank; Habel, Ute

    2012-12-01

    Empathy is a rather elaborated human ability and several recent studies highlight significant impairments in patients suffering from psychiatric disorders, such as schizophrenia, bipolar disorder or major depression. Therefore, the present study aimed at comparing behavioral empathy performance in schizophrenia, bipolar and depressed patients with healthy controls. All subjects performed three tasks tapping the core components of empathy: emotion recognition, emotional perspective taking and affective responsiveness. Groups were matched for age, gender, and verbal intelligence. Data analysis revealed three main findings: First, schizophrenia patients showed the strongest impairment in empathic performance followed by bipolar patients while depressed patients performed similar to controls in most tasks, except for affective responsiveness. Second, a significant association between clinical characteristics and empathy performance was only apparent in depression, indicating worse affective responsiveness with stronger symptom severity and longer duration of illness. Third, self-report data indicate that particularly bipolar patients describe themselves as less empathic, reporting less empathic concern and less perspective taking. Taken together, this study constitutes the first approach to directly compare specificity of empathic deficits in severe psychiatric disorders. Our results suggest disorder-specific impairments in emotional competencies that enable better characterization of the patient groups investigated and indicate different psychotherapeutic interventions. PMID:23116884

  20. Efficacy of repetitive transcranial magnetic stimulation with quetiapine in treating bipolar II depression: a randomized, double-blinded, control study

    PubMed Central

    Hu, Shao-hua; Lai, Jian-bo; Xu, Dong-rong; Qi, Hong-li; Peterson, Bradley S.; Bao, Ai-min; Hu, Chan-chan; Huang, Man-li; Chen, Jing-kai; Wei, Ning; Hu, Jian-bo; Li, Shu-lan; Zhou, Wei-hua; Xu, Wei-juan; Xu, Yi

    2016-01-01

    The clinical and cognitive responses to repetitive transcranial magnetic stimulation (rTMS) in bipolar II depressed patients remain unclear. In this study, thirty-eight bipolar II depressed patients were randomly assigned into three groups: (i) left high-frequency (n = 12), (ii) right low-frequency (n = 13), (iii) sham stimulation (n = 13), and underwent four-week rTMS with quetiapine concomitantly. Clinical efficacy was evaluated at baseline and weekly intervals using the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive functioning was assessed before and after the study with the Wisconsin Card Sorting Test (WCST), Stroop Word-Color Interference Test (Stroop), and Trail Making Test (TMT). Thirty-five patients were included in the final analysis. Overall, the mean scores of both the HDRS-17 and the MADRS significantly decreased over the 4-week trial, which did not differ among the three groups. Exploratory analyses revealed no differences in factor scores of HDRS-17s, or in response or remission rates. Scores of WCST, Stroop, or TMT did not differ across the three groups. These findings indicated active rTMS combined with quetiapine was not superior to quetiapine monotherapy in improving depressive symptoms or cognitive performance in patients with bipolar II depression. PMID:27460201

  1. Efficacy of repetitive transcranial magnetic stimulation with quetiapine in treating bipolar II depression: a randomized, double-blinded, control study.

    PubMed

    Hu, Shao-Hua; Lai, Jian-Bo; Xu, Dong-Rong; Qi, Hong-Li; Peterson, Bradley S; Bao, Ai-Min; Hu, Chan-Chan; Huang, Man-Li; Chen, Jing-Kai; Wei, Ning; Hu, Jian-Bo; Li, Shu-Lan; Zhou, Wei-Hua; Xu, Wei-Juan; Xu, Yi

    2016-01-01

    The clinical and cognitive responses to repetitive transcranial magnetic stimulation (rTMS) in bipolar II depressed patients remain unclear. In this study, thirty-eight bipolar II depressed patients were randomly assigned into three groups: (i) left high-frequency (n = 12), (ii) right low-frequency (n = 13), (iii) sham stimulation (n = 13), and underwent four-week rTMS with quetiapine concomitantly. Clinical efficacy was evaluated at baseline and weekly intervals using the 17-item Hamilton Depression Rating Scale (HDRS-17) and Montgomery-Asberg Depression Rating Scale (MADRS). Cognitive functioning was assessed before and after the study with the Wisconsin Card Sorting Test (WCST), Stroop Word-Color Interference Test (Stroop), and Trail Making Test (TMT). Thirty-five patients were included in the final analysis. Overall, the mean scores of both the HDRS-17 and the MADRS significantly decreased over the 4-week trial, which did not differ among the three groups. Exploratory analyses revealed no differences in factor scores of HDRS-17s, or in response or remission rates. Scores of WCST, Stroop, or TMT did not differ across the three groups. These findings indicated active rTMS combined with quetiapine was not superior to quetiapine monotherapy in improving depressive symptoms or cognitive performance in patients with bipolar II depression. PMID:27460201

  2. Antihypertensive therapy in patients on chronic lithium treatment for bipolar disorders.

    PubMed

    Bisogni, Valeria; Rossitto, Giacomo; Reghin, Francesco; Padrini, Roberto; Rossi, Gian Paolo

    2016-01-01

    Bipolar disorders are chronic conditions treated with lithium, which exerts deleterious effects on the kidney, among which nephrogenic diabetes insipidus, tubular acidosis and ultimately chronic kidney disease. Conversely, drugs that alter renal function can modify its serum levels and lead to the potentially fatal lithium intoxication. A search in the main library databases from 1975 to 2015 to identify interactions between antihypertensive drugs and lithium using the Population Intervention Comparison Outcome strategy provided only 30 reports of lithium intoxication. A regression analysis showed that the severity of lithium intoxication was significantly predicted by female, age, and use of certain classes of antihypertensive agents. A model including certain albeit not all diuretics and/or inhibitors of the renin-angiotensin system, but not age, serum lithium or creatinine levels at baseline and/or on admission to the hospital, predicted lithium toxicity. The true incidence of lithium intoxication is unknown but probably low, albeit underestimated. Nonetheless, in patients treated with lithium, monitoring of the serum lithium levels and clinical conditions is mandatory after the introduction of antihypertensive drugs, as diuretics and renin-aldosterone system inhibitors. PMID:26630207

  3. Results From an Online Survey of Patient and Caregiver Perspectives on Unmet Needs in the Treatment of Bipolar Disorder

    PubMed Central

    Tracy, Natasha

    2014-01-01

    Objective: To look at the manner in which patients and caregivers perceive the treatment of bipolar disorder compared with the evidence base for bipolar treatment. Method: Between April 2013 and March 2014, 469 respondents took a 14-question online survey on demographics, medications taken, and perspectives on bipolar treatment and medications. Participants were recruited through social media outlets (Facebook and Twitter accounts) of Global Medical Education (New York, New York) and the blog Bipolar Burble, which has a primary audience of people with bipolar disorder. There were no exclusion criteria to participation, and both patients and health care professionals were encouraged to participate. Results: Most respondents were taking ≥ 3 medications, and the greatest unmet need in treatment was for bipolar depression. In general, respondent perspectives on the effectiveness of individual medication treatments did not align with the available literature. Weight gain was the greatest side effect concern for both antipsychotics and mood stabilizers. Conclusions: Our survey demonstrates that there are still many unmet needs in the treatment of bipolar disorder. There is also a mismatch between the evidence base for treatments in bipolar disorder and patient perception of the relative efficacy of different medications. In order to achieve better outcomes, there is a need to provide patients and clinicians greater quality education with regard to the best evidence-based treatments for bipolar disorder. PMID:25664214

  4. [Nursing care of a patient with bipolar disorder and lithium-induced nephrogenic diabetes insipidus].

    PubMed

    García de la Orden, Lucía; García Carretero, Rafael

    2015-01-01

    Bipolar disorder is one of the most common, severe and persistent mental disorders. The evaluation of all data and variables related to bipolar disorder is a difficult task, because there is no clear agreement on what should be included in this category. One of the traditional treatments for this disease is the lithium metal that is administered in the form of lithium salt. Lithium has a narrow therapeutic window and there is a significant risk of complications arising from its use, mainly neurological and renal. In the case presented, the preparation of a care plan is described for a patient diagnosed with bipolar disorder who suffered a complication with lithium treatment. To do this, it was decided to use a standardized care plan and later completed it with diagnostic, objectives and interventions to the specific needs of the patient, aimed at achieving optimal levels of independence. PMID:25600576

  5. Decrease of event-related delta oscillations in euthymic patients with bipolar disorder.

    PubMed

    Atagün, Murat İlhan; Güntekin, Bahar; Maşalı, Belinda; Tülay, Elif; Başar, Erol

    2014-07-30

    Decreased delta oscillation upon cognitive load is common in patients with Alzheimer׳s disease, mild cognitive impairment, and schizophrenia. However, there is no previous study analyzing the delta responses in euthymic medication-free patients with bipolar disorder. Participants comprised of 22 euthymic medication-free patients with DSM-IV diagnoses of bipolar disorder and 21 healthy controls who were matched to the patients for sex, age, and education. Electroencephalographic activity was recorded at 30 electrode sites using an application of an auditory oddball paradigm. The maximum peak-to-peak amplitudes for each subject׳s averaged delta response (0.5-3.5Hz) were measured. There was a significant inter-group difference in evoked and event-related delta (0.5-3.5Hz) responses. Post-hoc comparisons revealed that the event-related delta oscillatory responses of the bipolar patient group were significantly lower than those of the healthy control group over the temporo-parietal and occipital electrode sites. Euthymic bipolar patients showed reduced event-related delta oscillatory responses in comparison to healthy subjects under cognitive load. The decrease of delta oscillations may be a common phenomenon that can be observed in different neuropsychiatric disorders with cognitive dysfunction. PMID:24819306

  6. A Cross-sectional, Comparative Study of Insight in Schizophrenia and Bipolar Patients in Remission

    PubMed Central

    Ramachandran, Arul Saravanan; Ramanathan, Rajkumar; Praharaj, Samir Kumar; Kanradi, Haridas; Sharma, Podila Satya Venkata Narasimha

    2016-01-01

    Aims: To study insight correlates in schizophrenia and bipolar mood disorder in remission among out-patients attending the Psychiatry Department of a Tertiary Care Hospital. Settings and Design: In a cross-sectional, naturalistic study, adult patients with schizophrenia and bipolar mood disorder in remission (n = 80; schizophrenia-40, mania-20, bipolar depression-20) were compared on insight measures and clinical correlates. Materials and Methods: Scale to Assess the Unawareness of Mental Disorders (SUMD) was used as the main tool to assess current and past measures of insight. Hogan's Drug Attitude Inventory was used to assess the drug attitude and compliance. Positive and Negative Symptom Scale for Schizophrenia, Young's Mania Rating Scale, and HAMD were used to rate psychopathology. Clinical Global Improvement was used as a screening tool for remission. Statistical Analysis: For comparison of the three clinical groups, analysis of variance and Chi-square test were used. In the post-hoc analysis, the Ryan-Einot-Gabriel-Welsch test was used to find the group difference. Results: About 40% in the schizophrenia group were unaware of their mental illness as against none in the bipolar group. The awareness of mental disorder for the current period, the awareness of the achieved effects of medications, and the awareness of social consequence was better in the bipolar group. The drug attitude (compliant positive attitude) increased as the SUMD item scale decreased or in other words, as the insight improved. Conclusions: Insight, both current and retrospect, showed significant differences between the schizophrenia and bipolar patients. Insight is significantly correlated with the observed compliance and drug attitude of the patient groups. PMID:27335515

  7. Monocyte and microglial activation in patients with mood-stabilized bipolar disorder

    PubMed Central

    Jakobsson, Joel; Bjerke, Maria; Sahebi, Sara; Isgren, Anniella; Ekman, Carl Johan; Sellgren, Carl; Olsson, Bob; Zetterberg, Henrik; Blennow, Kaj; Pålsson, Erik; Landén, Mikael

    2015-01-01

    Background Bipolar disorder is associated with medical comorbidities that have been linked to systemic inflammatory mechanisms. There is, however, limited evidence supporting a role of neuroinflammation in bipolar disorder. Here we tested whether microglial activation and associated tissue remodelling processes are related to bipolar disorder by analyzing markers in cerebrospinal fluid (CSF) and serum from patients and healthy controls. Methods Serum was sampled from euthymic patients with bipolar disorder and healthy controls, and CSF was sampled from a large subset of these individuals. The levels of monocyte chemoattractant protein-1 (MCP-1), YKL-40, soluble cluster of differentiation 14 (sCD14), tissue inhibitor of metalloproteinases-1 (TIMP-1) and tissue inhibitor of metalloproteinases-2 (TIMP-2), were measured, and we adjusted comparisons between patients and controls for confounding factors. Results We obtained serum samples from 221 patients and 112 controls and CSF samples from 125 patients and 87 controls. We found increased CSF levels of MCP-1 and YKL-40 and increased serum levels of sCD14 and YKL-40 in patients compared with controls; these differences remained after controlling for confounding factors, such as age, sex, smoking, blood–CSF barrier function, acute-phase proteins and body mass index. The CSF levels of MCP-1 and YKL-40 correlated with the serum levels, whereas the differences between patients and controls in CSF levels of MCP-1 and YKL-40 were independent of serum levels. Limitations The cross-sectional study design precludes conclusions about causality. Conclusion Our results suggest that both neuroinflammatory and systemic inflammatory processes are involved in the pathophysiology of bipolar disorder. Importantly, markers of immunological processes in the brain were independent of peripheral immunological activity. PMID:25768030

  8. An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

    ERIC Educational Resources Information Center

    Eisner, Lori R.; Johnson, Sheri L.

    2008-01-01

    Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric…

  9. Patients' Expectancies, the Alliance in Pharmacotherapy, and Treatment Outcomes in Bipolar Disorder

    ERIC Educational Resources Information Center

    Gaudiano, Brandon A.; Miller, Ivan W.

    2006-01-01

    Bipolar disorder is characterized by a chronic and fluctuating course of illness. Although nonadherence to pharmacotherapy is a frequent problem in the disorder, few studies have systematically explored psychosocial factors related to treatment discontinuation. Previous research with depressed patients receiving psychotherapy has suggested that…

  10. Relationship between personality traits and perceived internalized stigma in bipolar patients and their treatment partners.

    PubMed

    Bassirnia, Anahita; Briggs, Jessica; Kopeykina, Irina; Mednick, Amy; Yaseen, Zimri; Galynker, Igor

    2015-12-15

    Internalized stigma of mental disorders has significant negative outcomes for patients with bipolar disorder and their families. The aim of this study is to evaluate the association between personality traits and internalized stigma of mental disorders in bipolar patients and their treatment partners. Five different questionnaires were utilized in this study: (1) Demographic data questionnaire, (2) Millon Clinical Multiaxial Inventory-III (MCMI-III) for personality traits, (3) Internalized Stigma of Mental Illness (ISMI) for stigma, (4) Self Report Manic Inventory (SRMI) for mania and (5) Center for Epidemiological Studies-Depression Scale (CES-D) for depression. The scores of personality traits were combined to create externalizing and internalizing personality trait scores. Results showed that patients with bipolar disorder and their treatment partners both experienced internalized stigma of mental health disorders. There was a significant positive correlation between internalized stigma and internalizing personality traits, but not externalizing traits. In a multi-variate regression analysis, internalizing personality trait score was found to be a significant predictor of internalized stigma. In conclusion, patients with bipolar disorder and their treatment partners perceive higher level of internalized stigma of mental disorders if they have internalizing personality traits. PMID:26421901

  11. When to start aripiprazole therapy in patients with bipolar mania.

    PubMed

    Sayyaparaju, Kiran Kumar; Grunze, Heinz; Fountoulakis, Kostas N

    2014-01-01

    Aripiprazole is a third generation atypical antipsychotic with compelling evidence as a highly effective treatment option in the management of acute manic and mixed episodes of bipolar I disorders. It has a unique mode of action, acting as a partial agonist at dopamine D2 and D3, and serotonin 5-HT1A; and exhibiting antagonistic action at the 5-HT2A and H1 receptors. Overall, it has a favorable safety and tolerability profile, with low potential for clinically significant weight gain and metabolic effects, especially compared to other well-established treatments. It also has a superior tolerability profile when used as maintenance treatment. Side effects like headache, insomnia, and extrapyramidal side effects (EPSEs), such as tremor and akathisia may be treatment limiting in some cases. It is efficacious in both acute mania and mixed states, and in the long-term prevention of manic relapses. Aripiprazole therefore, is a significant player in the current portfolio of anti-manic pharmacological treatments. The data sources for this article are from EMBASE, MEDLINE, and the clinical trial database searches for all the literature published between January 2003 and September 2013. The key search terms were "aripiprazole" combined with "bipolar disorder", "mania", "antipsychotics", "mood stabilizer", "randomized controlled trial", and "pharmacology". Abstracts and proceedings from national and international psychiatric meetings were also reviewed, along with reviews of the reference lists of relevant articles. PMID:24648740

  12. [Neuroprogression and cognition in Bipolar Disorders: A systematic review of cognitive performance in euthymic patients].

    PubMed

    Lolich, María; Holtzman, Jessica N; Rago, Carlo M; Vázquez, Gustavo H

    2015-01-01

    In recent years, investigators have begun to consider the possibility of explaining the physiopathology of bipolar disorder from a neuroprogressive perspective. The evidence that supports the feasibility of such an approach is varied, and arises from neuroimaging studies, batteries of neurocognitive evaluations, and tests to identify the specific biomarkers of the disorder. The present article seeks to perform a review of the research that investigates the cognitive deficits in bipolar disorder. A bibliographic revision was performed of articles published between 1990 and 2015. Levels of cognitive performance were explored in both cross-sectional and longitudinal studies. The compiled studies signal the presence of altered cognitive function, even during periods of euthymia. However, there are contradictory results as to whether bipolar disorder presents a degenerative course. New lines of investigation suggest that only a percentage of individuals with bipolar disorder are affected in a progressive manner. It is of paramount importance to perform new longitudinal studies in high-risk populations, so as to validate or refute a neuroprogressive model of cognitive deficits in patients with bipolar disorder. PMID:26672503

  13. Treating drug-dependent patients in hospitals.

    PubMed

    Skene, Loane; Keays, David; Gardner, Bruce

    2002-08-01

    Are hospital staff legally permitted to test drug-dependent patients for drugs or infectious disease without the patient's consent in order to treat the patient or to protect themselves or other patients? What should staff do with "suspicious" items in the patient's possession (drugs, credit cards in different names, firearms)? Can drug-dependent patients lawfully use illicit drugs in hospital? Who should supply and administer them? PMID:12242876

  14. Clinical usefulness of second-generation antipsychotics in treating children and adolescents diagnosed with bipolar or schizophrenic disorders.

    PubMed

    Gentile, Salvatore

    2011-10-01

    The onset of severe, chronic or recurrent psychiatric illnesses, such as schizophrenia-spectrum and bipolar disorders, is a dramatic clinical event often detectable during adolescence and even in childhood. At any age, pharmacotherapy, along with enhancement of social skills and family support, is the mainstay for the management of such disorders. The aim of this review is to critically analyze findings from randomized controlled trials (RCTs) that have investigated the clinical utility of second-generation antipsychotics (SGAs) for the treatment of early-onset schizophrenia and bipolar disorders. Eighteen studies were considered, all of which were unfortunately impaired by methodologic limitations, such as the paucity of long-term data and lack of a three-arm comparison (SGA vs SGA vs placebo). Nevertheless, the results of this review allow us to suggest the effectiveness of three SGAs (aripiprazole, olanzapine, and risperidone) in the short-term treatment of both early-onset schizophrenia and bipolar mania, although such agents show different safety profiles. The use of clozapine should be strictly limited to patients with non-affective, psychotic symptoms who do not respond to any of these three SGAs. In contrast, the use of quetiapine and ziprasidone in young patients with either affective or non-affective psychosis is not yet supported by evidence-based information. Given our findings, further studies are urgently required to identify the best treatment option(s) for pediatric bipolar disorder (especially the depressive phase) and the long-term management of early-onset schizophrenia. PMID:21888443

  15. Working Memory and Response Inhibition in Patients With Bipolar I Disorder During Euthymic Period

    PubMed Central

    Farahmand, Zahra; Tehrani-Doost, Mehdi; Amini, Homayoun; Mohammadi, Abolfazl; Mirzaei, Mosleh; Mohamadzadeh, Azar

    2015-01-01

    Background: Several cognitive domains, including attention, memory, and executive functions are impaired in bipolar disorder. Objectives: This study aimed to investigate two executive functions (working memory and response inhibition) in patients with bipolar I disorder during remission of the symptoms. Patients and Methods: In this case-control design, 30 bipolar I patients (18 to 45 years old) were matched with 30 ones in the control group in terms of age, gender, and education. The patients were selected from Roozbeh Psychiatric Hospital (a hospital affiliated to Tehran University of Medical Sciences) from May to October 2013. They were evaluated and contrasted using working memory (Spatial Span and Spatial Working Memory (SSP and SWM)) and response inhibition (Stop Signal Task (SST)) tests. Results: We used independent t-tests for comparing and contrasting 2 groups on total and sub-scales scores of these 3 tests. In terms of SWM test there was a significant difference in between-group error between the two groups (P = 0.05); there was also a meaningful difference between the strategies used by two groups (P = 0.05). In SSP test, a significant difference appeared between averages of span length of the two groups. In the first and last item delays, there was also a clear difference, but the total error index was not noticeably different. In SST test, the direction error indicator in start-stop trials indicated a major difference, while in successful stops ratio, the case group had a lower ratio. In addition, reaction time to stop signs in bipolar group was meaningfully lower than the control group. Conclusion: In conclusion, even during remission phase, executive dysfunction is detectable at least in some areas in patients with bipolar disorder. PMID:26251656

  16. CRY1 Variations Impacts on the Depressive Relapse Rate in a Sample of Bipolar Patients

    PubMed Central

    Monti, Barbara; De Ronchi, Diana; Serretti, Alessandro

    2015-01-01

    Objective A relevant part of the social and personal burden caused by Bipolar Disorder (BD) is related to depressive phases. Authors investigated the genetic impact of a set of variations located in CRY1, a gene involved in the control of the circadian rhythms, towards depressive episodes in a sample of bipolar patients from the STEP-BD sample. As a secondary analysis, CYR1 variations were analyzed as predictors of sleep disruption. Methods 654 bipolar patients were included in the analysis. Data were available genome-wide. The part of the genome coding for the CRY1 was imputed and pruned according to standards in the field. 7 SNPs were available for the analysis. A correction for multitesting was applied and we had sufficient power (0.80) to detect a small-medium effect size (0.22) between two allelic frequencies each one represented by at least 300 subjects. Results Intronic rs10861688 was associated with the number of depressive events corrected for the times patients were assessed during the period of observation. In particular, AA subjects (n=21) had 4.46±3.15 events, AG (n=141) had 3.08±3.17 and GG (n=342) 2.65±2.97 (p=0.0048, beta=-0.22). No other significant associations were reported. Conclusion We bring further evidence that genes involved in the regulation of circadian rhythms may be relevant to depressive bipolar phases. Independent confirmation analyses are mandatory. PMID:25670954

  17. How Patients Contribute to an Online Psychoeducation Forum for Bipolar Disorder: A Virtual Participant Observation Study

    PubMed Central

    Smith, Daniel; Simpson, Sharon

    2015-01-01

    Background In a recent exploratory randomized controlled trial, an online psychoeducation intervention for bipolar disorder has been found to be feasible and acceptable to patients and may positively impact on their self-management behaviors and quality of life. Objective The objective of the study was to investigate how these patients contribute to an online forum for bipolar disorder and the issues relevant for them. Methods Participants in the intervention arm of the Bipolar Interactive PsychoEDucation (“BIPED”) trial were invited to contribute to the Beating Bipolar forum alongside receiving interactive online psychoeducation modules. Within this virtual participant observation study, forum posts were analyzed using thematic analysis, incorporating aspects of discourse analysis. Results The key themes which arose from the forum posts included: medication, employment, stigma, social support, coping strategies, insight and acceptance, the life chart, and negative experiences of health care. Participants frequently provided personal narratives relating to their history of bipolar disorder, life experiences, and backgrounds, which often contained emotive language and humor. They regularly sought and offered advice, and expressed encouragement and empathy. The forum would have benefitted from more users to offer a greater support network with more diverse views and experiences. Conclusions Online forums are inexpensive to provide and may offer peer support and the opportunity for patients to share their experiences and explore issues related to their illness anonymously. Future research should focus on how to enhance patient engagement with online health care forums. Trial Registration ISRCTN81375447; http://www.isrctn.com/ISRCTN81375447 (Archived by WebCite at http://www.webcitation.org/6YzWtHUqu). PMID:26543925

  18. Evidence-based guidelines for treating bipolar disorder: revised third edition Recommendations from the British Association for Psychopharmacology

    PubMed Central

    Goodwin, G.M.; Haddad, P. M.; Ferrier, I.N.; Aronson, J.K.; Barnes, T.R.H.; Cipriani, A.; Coghill, D.R.; Fazel, S.; Geddes, J.R.; Grunze, H.; Holmes, E.A.; Howes, O.; Hudson, S.; Hunt, N.; Jones, I.; Macmillan, I.C.; McAllister-Williams, H.; Miklowitz, D.M.; Morriss, R.; Munafò, M.; Paton, C.; Saharkian, B.J.; Saunders, K.E.A.; Sinclair, J.M.A.; Taylor, D.; Vieta, E.; Young, A.H.

    2016-01-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines: in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

  19. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology.

    PubMed

    Goodwin, G M; Haddad, P M; Ferrier, I N; Aronson, J K; Barnes, Trh; Cipriani, A; Coghill, D R; Fazel, S; Geddes, J R; Grunze, H; Holmes, E A; Howes, O; Hudson, S; Hunt, N; Jones, I; Macmillan, I C; McAllister-Williams, H; Miklowitz, D R; Morriss, R; Munafò, M; Paton, C; Saharkian, B J; Saunders, Kea; Sinclair, Jma; Taylor, D; Vieta, E; Young, A H

    2016-06-01

    The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change. PMID:26979387

  20. Diltiazem as augmentation therapy in patients with treatment-resistant bipolar disorder: a retrospective study.

    PubMed Central

    Silverstone, P H; Birkett, L

    2000-01-01

    OBJECTIVE: To examine the efficacy of a slow-release formulation of diltiazem as adjunctive therapy in patients with treatment-resistant bipolar disorder. DESIGN: Retrospective study. PATIENTS: Eight female patients with treatment-resistant bipolar disorder. INTERVENTIONS: Patients were administered diltiazem and monitored for a 6-month period before starting diltiazem and a 6-month period after starting the drug. OUTCOME MEASURES: All patients were seen at least monthly and usually every 2 weeks. The frequency and severity of both depressive and manic episodes were examined during the 6-month period after starting diltiazem, and compared with those during the 6-month period before diltiazem treatment. RESULTS: There was a statistically significant decrease in the frequency and severity of both manic and depressive episodes in these patients after they started treatment with diltiazem, compared with the period before they started treatment with diltiazem (p < 0.001). There was no evidence of side effects requiring patient withdrawal or of drug interactions. CONCLUSIONS: The results support previous suggestions that calcium-channel antagonists may be an effective adjunctive treatment in the management of bipolar disorder. Further controlled clinical studies are needed to confirm this small, open-label, retrospective study. PMID:10863888

  1. Greater Trochanter Reconstruction in Unstabl Intertrochanteric Fractures Treated With Cemented Bipolar Hemiarthroplasty: A Technical Note

    PubMed Central

    Subramanian, G V; Guravareddy, A V; Reddy, Anil Kumar K R; Chiranjeevi, T

    2012-01-01

    Cemented Bipolar arthroplasty is an established method for treatment of comminuted Intertrochanteric fractures. Reconstruction of greater trochanter is an essential technical step to avoid complications like abductor lurch gait. We here describe a technique of reconstruction and fixation of greater trochanter using cancellous screws with wide washers made of reconstruction plate and tension band wiring. This gives a stable fixation of greater trochanter and avoids cut out, slippage of implants.

  2. Greater Trochanter Reconstruction in Unstabl Intertrochanteric Fractures Treated With Cemented Bipolar Hemiarthroplasty: A Technical Note.

    PubMed

    Subramanian, G V; Guravareddy, A V; Reddy, Anil Kumar K R; Chiranjeevi, T

    2012-01-01

    Cemented Bipolar arthroplasty is an established method for treatment of comminuted Intertrochanteric fractures. Reconstruction of greater trochanter is an essential technical step to avoid complications like abductor lurch gait. We here describe a technique of reconstruction and fixation of greater trochanter using cancellous screws with wide washers made of reconstruction plate and tension band wiring. This gives a stable fixation of greater trochanter and avoids cut out, slippage of implants. PMID:27298870

  3. Preliminary examination of microRNA expression profiling in bipolar disorder I patients during antipsychotic treatment.

    PubMed

    Lim, Chor Hong; Zainal, Nor Zuraida; Kanagasundram, Sharmilla; Zain, Shamsul Mohd; Mohamed, Zahurin

    2016-09-01

    Although major progress has been achieved in research and development of antipsychotic medications for bipolar disorder (BPD), knowledge of the molecular mechanisms underlying this disorder and the action of atypical antipsychotics remains incomplete. The levels of microRNAs (miRNAs)-small non-coding RNA molecules that regulate gene expression, including genes involved in neuronal function and plasticity-are frequently altered in psychiatric disorders. This study aimed to examine changes in miRNA expression in bipolar mania patients after treatment with asenapine and risperidone. Using a miRNA microarray, we analyzed miRNA expression in the blood of 10 bipolar mania patients following 12 weeks of treatment with asenapine or risperidone. Selected miRNAs were validated by using real-time PCR. A total of 16 miRNAs were differentially expressed after treatment in the asenapine group, 14 of which were significantly upregulated and the other two significantly downregulated. However, all three differentially expressed miRNAs in the risperidone group were downregulated. MiRNA target gene prediction and gene ontology analysis revealed significant enrichment for pathways associated with immune system response and regulation of programmed cell death and transcription. Our results suggest that candidate miRNAs may be involved in the mechanism of action of both antipsychotics in bipolar mania. © 2016 Wiley Periodicals, Inc. PMID:27177356

  4. What is the real significance and management of major thyroid disorders in bipolar patients?

    PubMed

    Sierra, Pilar; Cámara, Rosa; Tobella, Helena; Livianos, Lorenzo

    2014-01-01

    Thyroid disfunction affects negatively emotional stability and worsens the clinical course of bipolar affective disorder. The main stabilizer used in this illness, lithium carbonate has numerous effects on the physiology of the thyroid, with the most significant being the inhibition of thyroid hormone release that may occur at therapeutic levels. These dysfunctions have also been reported most frequently in bipolar patients not undergoing treatment with lithium, and was not completely explained by the effects of this drug. Apart from the numerous medical complications and mood disturbances, the cognitive or perceptual system may also be affected. In fact, the presence of thyroid disease increases the rates of obsessive compulsive disorder, phobias, panic disorder, major depressive disorder, cyclothymia, or bipolar disorder. In severe cases of hypothyroidism, the clinical symptoms and signs can be similar to a melancholic depression or dementia. It is therefore important to know well all these possible complications in daily clinical practice. This review will cover the main thyroid dysfunctions present in bipolar patients, whether ot not produced by treatment with lithium carbonate, and will provide a series of recommendations for clinical management. PMID:24462913

  5. Divergent relationship of depression severity to social reward responses among patients with bipolar versus unipolar depression.

    PubMed

    Sharma, Anup; Satterthwaite, Theodore D; Vandekar, Lillie; Katchmar, Natalie; Daldal, Aylin; Ruparel, Kosha; Elliott, Mark A; Baldassano, Claudia; Thase, Michael E; Gur, Raquel E; Kable, Joseph W; Wolf, Daniel H

    2016-08-30

    Neuroimaging studies of mood disorders demonstrate abnormalities in brain regions implicated in reward processing. However, there is a paucity of research investigating how social rewards affect reward circuit activity in these disorders. Here, we evaluated the relationship of both diagnostic category and dimensional depression severity to reward system function in bipolar and unipolar depression. In total, 86 adults were included, including 24 patients with bipolar depression, 24 patients with unipolar depression, and 38 healthy comparison subjects. Participants completed a social reward task during 3T BOLD fMRI. On average, diagnostic groups did not differ in activation to social reward. However, greater depression severity significantly correlated with reduced bilateral ventral striatum activation to social reward in the bipolar depressed group, but not the unipolar depressed group. In addition, decreased left orbitofrontal cortical activation correlated with more severe symptoms in bipolar depression, but not unipolar depression. These differential dimensional effects resulted in a significant voxelwise group by depression severity interaction. Taken together, these results provide initial evidence that deficits in social reward processing are differentially related to depression severity in the two disorders. PMID:27295401

  6. Divergent Relationship of Depression Severity to Social Reward Responses Among Patients with Bipolar Versus Unipolar Depression

    PubMed Central

    Sharma, Anup; Satterthwaite, Theodore D.; Vandekar, Lillie; Katchmar, Natalie; Daldal, Aylin; Ruparel, Kosha; A.Elliott, Mark; Baldassano, Claudia; Thase, Michael E.; Gur, Raquel E.; Kable, Joseph W.; Wolf, Daniel H.

    2016-01-01

    Neuroimaging studies of mood disorders demonstrate abnormalities in brain regions implicated in reward processing. However, there is a paucity of research investigating how social rewards affect reward circuit activity in these disorders. Here, we evaluated the relationship of both diagnostic category and dimensional depression severity to reward system function in bipolar and unipolar depression. In total, 86 adults were included, including 24 patients with bipolar depression, 24 patients with unipolar depression, and 38 healthy comparison subjects. Participants completed a social reward task during 3T BOLD fMRI. On average, diagnostic groups did not differ in activation to social reward. However, greater depression severity significantly correlated with reduced bilateral ventral striatum activation to social reward in the bipolar depressed group, but not the unipolar depressed group. In addition, decreased left orbitofrontal cortical activation correlated with more severe symptoms in bipolar depression, but not unipolar depression. These differential dimensional effects resulted in a significant voxelwise group by depression severity interaction. Taken together, these results provide initial evidence that deficits in social reward processing are differentially related to depression severity in the two disorders. PMID:27295401

  7. A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

    PubMed Central

    Park, Bong-Ju; Min, Woong-Bae

    2015-01-01

    Purpose To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation.

  8. The functional exercise capacity in patients with bipolar disorder versus healthy controls: A pilot study.

    PubMed

    Vancampfort, Davy; Wyckaert, Sabine; Sienaert, Pascal; De Hert, Marc; Stubbs, Brendon; Buys, Roselien; Schueremans, Ans; Probst, Michel

    2015-09-30

    The aim of the current study was to compare the functional exercise capacity of patients with bipolar disorder with age-, gender- and body mass index (BMI)-matched healthy controls. Thirty patients (16 ♂, 40.8±11.6 years) and healthy controls (16 ♂, 40.5±10.8 years) were included. All participants performed a 6-min walk test to assess the functional exercise capacity and completed the International Physical Activity Questionnaire. Patients were screened for psychiatric symptoms using the Quick Inventory of Depressive Symptomatology and Hypomania Checklist-32. Results demonstrated that patients with bipolar disorder demonstrated a significantly poorer functional exercise capacity (590.8±112.6 versus 704.2±94.3m). A backward stepwise regression analyses showed that the level of depression and existing foot or ankle static problems and back pain before the test explained 70.9% of the variance in the distance achieved on the 6-min walk test (functional exercise capacity). The current study demonstrates that foot and back pain appear to be important negative predictors of functional exercise capacity in patients with bipolar disorder. Physical activity interventions delivered by physical therapists may help ameliorate pain symptoms and improve functional exercise capacity. PMID:26208981

  9. Decrease of theta response in euthymic bipolar patients during an oddball paradigm.

    PubMed

    Atagün, M İ; Güntekin, B; Ozerdem, A; Tülay, E; Başar, E

    2013-06-01

    Theta oscillations are related to cognitive functions and reflect functional integration of frontal and medial temporal structures into coherent neurocognitive networks. This study assessed event-related theta oscillations in medication-free, euthymic patients with bipolar disorder upon auditory oddball paradigm. Twenty-two DSM-IV euthymic bipolar I (n = 19) and II (n = 3) patients and twenty-two healthy subjects were included. Patients were euthymic for at least 6 months, and psychotropic-free for at least 2 weeks. EEG was recorded at 30 electrode sites. Auditory oddball paradigm and sensory stimuli were used. Event-related Oscillations were analyzed using adaptive filtering in two different theta frequency bands (4-6 Hz, 6-8 Hz). In healthy subjects, slow theta (4-6 Hz) responses were significantly higher than those of euthymic patients upon target, non-target and sensory stimuli (p < 0.05). Fast theta (6-8 Hz) responses of healthy subjects were significantly higher than those of euthymic patients upon target-only stimuli (p < 0.05). Reduced theta oscillations during auditory processing provide strong quantitative evidence of activation deficits in related networks in bipolar disorder. Fast theta responses are related to cognitive functions, whereas slow theta responses are related to sensory processes more than cognitive processes. PMID:24427202

  10. Help With Bipolar Disorders

    MedlinePlus

    ... a Psychiatrist Patients & Families All Topics Help With Bipolar Disorders Curated and updated for the community by APA Topic Information Bipolar disorders are brain disorders that cause changes in a ...

  11. Designing a patient monitoring system for bipolar disorder using Semantic Web technologies.

    PubMed

    Thermolia, Chryssa; Bei, Ekaterini S; Petrakis, Euripides G M; Kritsotakis, Vangelis; Tsiknakis, Manolis; Sakkalis, Vangelis

    2015-01-01

    The new movement to personalize treatment plans and improve prediction capabilities is greatly facilitated by intelligent remote patient monitoring and risk prevention. This paper focuses on patients suffering from bipolar disorder, a mental illness characterized by severe mood swings. We exploit the advantages of Semantic Web and Electronic Health Record Technologies to develop a patient monitoring platform to support clinicians. Relying on intelligently filtering of clinical evidence-based information and individual-specific knowledge, we aim to provide recommendations for treatment and monitoring at appropriate time or concluding into alerts for serious shifts in mood and patients' non response to treatment. PMID:26737852

  12. Leukocyte telomere length positively correlates with duration of lithium treatment in bipolar disorder patients.

    PubMed

    Squassina, Alessio; Pisanu, Claudia; Congiu, Donatella; Caria, Paola; Frau, Daniela; Niola, Paola; Melis, Carla; Baggiani, Gioia; Lopez, Juan Pablo; Cruceanu, Cristiana; Turecki, Gustavo; Severino, Giovanni; Bocchetta, Alberto; Vanni, Roberta; Chillotti, Caterina; Del Zompo, Maria

    2016-07-01

    Bipolar disorder (BD) has been suggested to be associated with accelerated aging and premature cell senescence. While findings on shorter telomeres in BD are controversial, a recent study showed that long-term lithium treatment correlates with longer telomeres in BD. In our study, we sought to investigate the correlation between leukocyte telomere length (LTL) and long-term lithium treatment in a sample of 200 BD patients characterized for lithium response. We also compared data from two different methods commonly used to measure telomere length, quantitative PCR (qPCR) and quantitative fluorescence in situ hybridization (Q-FISH). We also measured, for the first time, the effect of lithium in vitro on the expression of the telomerase gene in human-derived neural progenitor cells (NPCs). Our findings showed that LTL correlated negatively with age (p=0.0002) and was independent of sex, diagnosis, age at onset, suicidal behavior, number of mood episodes, response to lithium and use of other psychotropic medications. After correcting for age, LTL was positively correlated with lithium treatment duration in patients treated for more than two years (n=150, R=0.17, p=0.037). There was a significant correlation between data measured with qPCR and Q-FISH (p=0.012, R=0.826). Lithium treatment increased telomerase expression in NPCs, though this effect was not statistically significant. Our data support previous findings showing that long-term lithium treatment associates with longer telomeres in BD, though this effect appeared to be independent from clinical response to the treatment. Moreover, we suggested for the first time that lithium increases the expression of telomerase gene in human neural progenitor cells. PMID:27084304

  13. Some experiences with treating thyroid cancer patients.

    PubMed

    Achey, B; Miller, K L; Erdman, M; King, S

    2001-05-01

    U.S. NRC Regulatory Guide 8.39 provides for the release of patients treated with 131I provided that predetermined calculations indicate that no member of the public will receive a total dose equivalent in excess of 5 mSv (500 mrem). When this condition cannot be met or there are other reasons for keeping the patient hospitalized after treatment, control of contamination and exposure from the patient must be taken into consideration. If the patients are hospitalized following treatment, decontaminating the patient's room after discharge and controlling the exposure potential from the patient are considerations for the hospital radiation safety staff. This paper reviews the experiences from fifty patients treated as inpatients over the past two years. PMID:11316085

  14. Ventricular fibrillation induced by coagulating mode bipolar electrocautery during pacemaker implantation in Myotonic Dystrophy type 1 patient.

    PubMed

    Russo, Vincenzo; Rago, Anna; DI Meo, Federica; Cioppa, Nadia Della; Papa, Andrea Antonio; Russo, Maria Giovanna; Nigro, Gerardo

    2014-12-01

    The occurrence of ventricular fibrillation, induced by bipolar electrocautery during elective dual chamber pacemaker implantation, is reported in a patient affected by Myotonic Distrophy type 1 with normal left ventricular ejection fraction. PMID:25873784

  15. Effective treatment of bipolar depression: monotherapy and combination strategies.

    PubMed

    Manning, J Sloan

    2015-11-01

    Managing patients with bipolar disorder remains a challenge due to its chronic nature. In addition, bipolar depression remains understudied even though patients spend more time in depressive episodes than in manic ones. Effective treatment requires an accurate and timely diagnosis, psychoeducation, psychotherapy, pharmacotherapy, and implementation of elements of the chronic care model. Pharmacologic strategies for treating bipolar depression differ from those for bipolar mania as well as those for unipolar depression and require knowledge of the efficacy and safety of agents including mood stabilizers, atypical antipsychotics, and antidepressants both as monotherapy and in combination. PMID:26646048

  16. Eye movement desensitization and reprocessing therapy in subsyndromal bipolar patients with a history of traumatic events: a randomized, controlled pilot-study.

    PubMed

    Novo, Patricia; Landin-Romero, Ramon; Radua, Joaquim; Vicens, Victor; Fernandez, Isabel; Garcia, Francisca; Pomarol-Clotet, Edith; McKenna, Peter J; Shapiro, Francine; Amann, Benedikt L

    2014-09-30

    Traumatic events are frequent in bipolar patients and can worsen the course of the disease. Psychotherapeutic interventions for these events have not been studied so far. Twenty DSM-IV bipolar I and II patients with subsyndromal mood symptoms and a history of traumatic events were randomly assigned to Eye Movement Desensitization and Reprocessing therapy (n=10) or treatment as usual (n=10). The treatment group received between 14 and 18 Eye Movement Desensitization and Reprocessing sessions during 12 weeks. Evaluations of affective symptoms, symptoms of trauma and trauma impact were carried out by a blind rater at baseline, 2 weeks, 5 weeks, 8 weeks, 12 weeks and at 24 weeks follow-up. Patients in the treatment group showed a statistically significant improvement in depressive and hypomanic symptoms, symptoms of trauma and trauma impact compared to the treatment as usual group after intervention. This effect was only partly maintained in trauma impact at the 24 weeks follow-up visit. One patient dropped from Eye Movement Desensitization and Reprocessing group whereas four from the treatment as usual group. This pilot study suggests that Eye Movement Desensitization and Reprocessing therapy may be an effective and safe intervention to treat subsyndromal mood and trauma symptoms in traumatized bipolar patients. PMID:24880581

  17. Impact of living with bipolar patients: Making sense of caregivers’ burden

    PubMed Central

    Pompili, Maurizio; Harnic, Désirée; Gonda, Xenia; Forte, Alberto; Dominici, Giovanni; Innamorati, Marco; Fountoulakis, Konstantinos N; Serafini, Gianluca; Sher, Leo; Janiri, Luigi; Rihmer, Zoltan; Amore, Mario; Girardi, Paolo

    2014-01-01

    The aim of the present review was to examine objective and subjective burdens in primary caregivers (usually family members) of patients with bipolar disorder (BD) and to list which symptoms of the patients are considered more burdensome by the caregivers. In order to provide a critical review about caregiver’s burden in patients with bipolar disorder, we performed a detailed PubMed, BioMedCentral, ISI Web of Science, PsycINFO, Elsevier Science Direct and Cochrane Library search to identify all papers and book chapters in English published during the period between 1963 and November 2011. The highest levels of distress were caused by the patient’s behavior and the patient’s role dysfunction (work, education and social relationships). Furthermore, the caregiving role compromises other social roles occupied by the caregiver, becoming part of the heavy social cost of bipolar affective disorder. There is a need to better understand caregivers’ views and personal perceptions of the stresses and demands arising from caring for someone with BD in order to develop practical appropriate interventions and to improve the training of caregivers. PMID:24660140

  18. Normal Metabolic Levels in Prefrontal Cortex in Euthymic Bipolar I Patients with and without Suicide Attempts

    PubMed Central

    Rocha, Marlos Vasconcelos; Nery-Fernandes, Fabiana; Guimarães, José Luiz; Quarantini, Lucas de Castro; de Oliveira, Irismar Reis; Ladeia-Rocha, Giovanna G.; Jackowski, Andrea Parolin; de Araujo Neto, César; Miranda-Scippa, Ângela

    2015-01-01

    Introduction/Objective. Evidence suggests that the prefrontal cortex has been implicated in the pathophysiology of bipolar disorder (BD), but few neurochemical studies have evaluated this region in bipolar patients and there is no information from BD suicide attempters using Proton Magnetic Resonance Spectroscopy (H+MRS). The objective was to evaluate the metabolic function of the medial orbital frontal cortex in euthymic BD type I suicide and nonsuicide attempters compared to healthy subjects by H+MRS. Methods. 40 euthymic bipolar I outpatients, 19 without and 21 with history of suicide attempt, and 22 healthy subjects were interviewed using the Structured Clinical Interview with the DSM-IV axis I, the Hamilton Depression Rating Scale, the Young Mania Rating Scale, and the Barratt Impulsiveness Scale-11 and underwent H+MRS. Results. We did not find any metabolic abnormality in medial orbital frontal regions of suicide and nonsuicide BD patients and BD patients as a group compared to healthy subjects. Conclusions. The combined chronic use of psychotropic drugs with neuroprotective or neurotrophic effects leading to a euthymic state for longer periods of time may improve neurometabolic function, at least measured by H+MRS, even in suicide attempters. Besides, these results may implicate mood dependent alterations in brain metabolic activity. However, more studies with larger sample sizes of this heterogeneous disorder are warranted to clarify these data. PMID:26075096

  19. Relapsing-remitting behavioural variant of frontotemporal dementia in a bipolar patient

    PubMed Central

    Vorspan, Florence; Bertoux, Maxime; Brichant-Petitjean, Clara; Dubois, Bruno; Lépine, Jean-Pierre

    2012-01-01

    Summary We report the case of a bipolar I patient who was diagnosed with frontotemporal dementia at the age of 54 during a manic episode. Her neurological state improved when this episode ended. Each subsequent thymic relapse was associated with cognitive deficits which subsided when the patient became euthymic, even though SPECT continued to show the same frontal hypoperfusion. We here discuss the hypothesis that the cognitive reserve of this patient, a former journalist, may, except during her mood episodes, have provided her with sufficient resources to meet her life demands despite her underlying neurological disorder. PMID:23402681

  20. Interaction between Personality and Mood in Unipolar and Bipolar Patients.

    ERIC Educational Resources Information Center

    Alexander, Gene E.; And Others

    Much of the literature on affective disorders has been devoted to categorizing, assessing, and treating the mood and behavioral symptoms typically associated with depressive illness, and much research has studied how personality traits interact with these state symptoms. The personality scales of the Millon Clinical Multiaxial Inventory (MCMI) are…

  1. Bipolar Disorder

    MedlinePlus

    ... might cause your mood changes. If not treated, bipolar disorder can lead to damaged relationships, poor job or school performance, and even suicide. However, there are effective treatments to control symptoms: medicine and talk therapy. A combination usually works best. NIH: National Institute ...

  2. Diminished serum repetin levels in patients with schizophrenia and bipolar disorder.

    PubMed

    Wang, Shuai; Ren, Huixun; Xu, Jie; Yu, Yanjun; Han, Shuiping; Qiao, Hui; Cheng, Shaoli; Xu, Chang; An, Shucheng; Ju, Bomiao; Yu, Chengyuan; Wang, Chanyuan; Wang, Tao; Yang, Zhenjun; Taylor, Ethan Will; Zhao, Lijun

    2015-01-01

    Repetin (RPTN) protein is a member of S100 family and is known to be expressed in the normal epidermis. Here we show that RPTN is ubiquitously expressed in both mouse and human brain, with relatively high levels in choroid plexus, hippocampus and prefrontal cortex. To investigate the expression of RPTN in neuropsychiatric disorders, we determined serum levels of RPTN in patients with schizophrenia (n = 88) or bipolar disorder (n = 34) and in chronic psychostimulant users (n = 91). We also studied its expression in a mouse model of chronic unpredictable mild stress (CUMS). The results showed that serum RPTN levels were significantly diminished in patients with schizophrenia and bipolar disorder or in psychostimulant users, compared with healthy subjects (n = 115) or age-matched controls (n = 92) (p < 0.0001). In CUMS mice, RPTN expression in hippocampus and prefrontal cortex was reduced with progression of the CUMS procedure; the serum RPTN level remained unchanged. Since CUMS is a model for depression and methamphetamine (METH) abuse induced psychosis recapitulates many of the psychotic symptoms of schizophrenia, the results from this study may imply that RPTN plays a potential role in emotional and cognitive processing; its decrease in serum may indicate its involvement in the pathogenesis of schizophrenia and bipolar disorder. PMID:25613293

  3. Anatomical abnormalities of the anterior cingulate and paracingulate cortex in patients with bipolar I disorder.

    PubMed

    Fornito, Alex; Malhi, Gin S; Lagopoulos, Jim; Ivanovski, Belinda; Wood, Stephen J; Saling, Michael M; Pantelis, Christos; Yücel, Murat

    2008-02-28

    Abnormalities of the anterior cingulate cortex (ACC) are thought to be involved in the pathophysiology of bipolar disorder, but structural Magnetic Resonance Imaging (MRI) studies have reported variable findings. Reasons for this include a failure to consider variability in regional cortical folding patterns and a reliance on relatively coarse measures (e.g., volume) to index anatomical change. We sought to overcome these limitations by combining a novel protocol for parcellating the ACC and adjacent paracingulate cortex (PaC) that accounts for inter-individual variations in sulcal and gyral morphology with a cortical surface-based approach that allowed calculation of regional grey matter volume, surface area and cortical thickness in 24 patients with bipolar I disorder and 24 matched controls. No changes in grey matter volume or surface area were identified in any region, but patients did show significant reductions in cortical thickness in the left rostral PaC and right dorsal PaC that were not attributable to group differences in cortical folding patterns. These findings suggest that bipolar disorder is associated with more pronounced changes in the PaC, and that reliance on volumetric measures alone may obscure more subtle differences. PMID:18207705

  4. Diminished serum repetin levels in patients with schizophrenia and bipolar disorder

    PubMed Central

    Wang, Shuai; Ren, Huixun; Xu, Jie; Yu, Yanjun; Han, Shuiping; Qiao, Hui; Cheng, Shaoli; Xu, Chang; An, Shucheng; Ju, Bomiao; Yu, Chengyuan; Wang, Chanyuan; Wang, Tao; Yang, Zhenjun; Taylor, Ethan Will; Zhao, Lijun

    2015-01-01

    Repetin (RPTN) protein is a member of S100 family and is known to be expressed in the normal epidermis. Here we show that RPTN is ubiquitously expressed in both mouse and human brain, with relatively high levels in choroid plexus, hippocampus and prefrontal cortex. To investigate the expression of RPTN in neuropsychiatric disorders, we determined serum levels of RPTN in patients with schizophrenia (n = 88) or bipolar disorder (n = 34) and in chronic psychostimulant users (n = 91). We also studied its expression in a mouse model of chronic unpredictable mild stress (CUMS). The results showed that serum RPTN levels were significantly diminished in patients with schizophrenia and bipolar disorder or in psychostimulant users, compared with healthy subjects (n = 115) or age-matched controls (n = 92) (p < 0.0001). In CUMS mice, RPTN expression in hippocampus and prefrontal cortex was reduced with progression of the CUMS procedure; the serum RPTN level remained unchanged. Since CUMS is a model for depression and methamphetamine (METH) abuse induced psychosis recapitulates many of the psychotic symptoms of schizophrenia, the results from this study may imply that RPTN plays a potential role in emotional and cognitive processing; its decrease in serum may indicate its involvement in the pathogenesis of schizophrenia and bipolar disorder. PMID:25613293

  5. Measuring patient outcomes and making the transition from acute to maintenance treatment for bipolar depression.

    PubMed

    Manning, J Sloan

    2015-12-01

    Patients with bipolar disorder require diligent management involving psychoeducation, a strong therapeutic alliance, and ongoing monitoring with rating scales to achieve the best outcomes. Clinicians should monitor symptom response, functioning, and quality of life to determine if treatment needs to be be adjusted. Assessing adverse effects must be done regularly to improve treatment adherence. Because effective acute phase treatments are often continued in maintenance treatment, clinicians must find the right balance of efficacy and tolerability for long-term success. The FDA has approved 7 agents for maintenance treatment of bipolar disorder. Because of the high risk of recurrent depressive episodes, clinicians should be aware of which agents are more effective for reducing manic or depressive relapses. PMID:26717538

  6. Smartphone-based recognition of states and state changes in bipolar disorder patients.

    PubMed

    Grünerbl, Agnes; Muaremi, Amir; Osmani, Venet; Bahle, Gernot; Ohler, Stefan; Tröster, Gerhard; Mayora, Oscar; Haring, Christian; Lukowicz, Paul

    2015-01-01

    Today's health care is difficult to imagine without the possibility to objectively measure various physiological parameters related to patients' symptoms (from temperature through blood pressure to complex tomographic procedures). Psychiatric care remains a notable exception that heavily relies on patient interviews and self-assessment. This is due to the fact that mental illnesses manifest themselves mainly in the way patients behave throughout their daily life and, until recently there were no "behavior measurement devices." This is now changing with the progress in wearable activity recognition and sensor enabled smartphones. In this paper, we introduce a system, which, based on smartphone-sensing is able to recognize depressive and manic states and detect state changes of patients suffering from bipolar disorder. Drawing upon a real-life dataset of ten patients, recorded over a time period of 12 weeks (in total over 800 days of data tracing 17 state changes) by four different sensing modalities, we could extract features corresponding to all disease-relevant aspects in behavior. Using these features, we gain recognition accuracies of 76% by fusing all sensor modalities and state change detection precision and recall of over 97%. This paper furthermore outlines the applicability of this system in the physician-patient relations in order to facilitate the life and treatment of bipolar patients. PMID:25073181

  7. Identification of high risk DISC1 protein structural variants in patients with bipolar spectrum disorder.

    PubMed

    Song, Wenjia; Li, Wenyan; Noltner, Katie; Yan, Jin; Green, Elaine; Grozeva, Detelina; Jones, Ian R; Craddock, Nick; Longmate, Jeff; Feng, Jinong; Sommer, Steve S

    2010-12-17

    In a large Scottish pedigree, a balanced translocation t (1;11)(q42.1;q14.3) disrupting the DISC1 and DISC2 genes segregates with major mental illness, including schizophrenia and depression. A frame-shift carboxyl-terminal deletion was reported in DISC1 in an American family with schizophrenia, but subsequently found in two controls. Herein, we test one hypothesis utilizing a large scale case-control mutation analysis: uncommon DISC1 variants are associated with high risk for bipolar spectrum disorder. We have analyzed the regions of likely functional significance in the DISC1 gene in 504 patients with bipolar spectrum disorder and 576 ethnically similar controls. Five patients were heterozygous for ultra-rare protein structural variants not found in the 576 controls (p=0.02, one-sided Fisher's exact test) and shown to be ultra-rare by their absence in a pool of 10,000 control alleles. In our sample, ultra-rare (private) protein structural variants in DISC1 are associated with an estimated attributable risk of about 0.5% in bipolar spectrum disorder. These data are consistent with: (i) the high frequency of depression in the large Scottish family with a translocation disrupting DISC1; (ii) linkage disequilibrium analysis demonstrating haplotypes associated with relatively small increases in risk for bipolar disorder (<3-fold odds ratio). The data illustrate how low/moderate risk haplotypes that might be found by the HapMap project can be followed up by resequencing to identify protein structural variants with high risk, low frequency and of potential clinical utility. PMID:20850505

  8. Course of illness in comorbid bipolar disorder and obsessive-compulsive disorder patients.

    PubMed

    Amerio, A; Tonna, M; Odone, A; Stubbs, B; Ghaemi, S N

    2016-04-01

    Psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). We updated our recent systematic review searching the electronic databases MEDLINE, Embase, and PsycINFO to investigate course of illness in BD-OCD patients. We identified a total of 13 relevant papers which found that the majority of comorbid OCD cases appeared to be related to mood episodes. OC symptoms in comorbid patients appeared more often during depressive episodes, and comorbid BD and OCD cycled together, with OC symptoms often remitting during manic/hypomanic episodes. PMID:27025465

  9. Bipolar Spectrum Disorders in a Clinical Sample of Patients with Internet Addiction: Hidden Comorbidity or Differential Diagnosis?

    PubMed Central

    Wölfling, Klaus; Beutel, Manfred E.; Dreier, Michael; Müller, Kai W.

    2015-01-01

    Background and Aims Behavioral addictions and bipolar disorders have a certain probability of co-occurrence. While the presence of a manic episode has been defined as an exclusion criterion for gambling disorder, no such exclusion has been formulated for Internet addiction. Methods A clinical sample of 368 treatment seekers presenting with excessive to addictive Internet use was screened for bipolar spectrum disorders using the Mood Disorder Questionnaire. Psychopathology was assessed by the Symptom Checklist 90R and a clinical interview was administered to screen for comorbid disorders. Results Comorbid bipolar disorders were more frequent in patients meeting criteria for Internet addiction (30.9%) than among the excessive users (5.6%). This subgroup showed heightened psychopathological symptoms, including substance use disorders, affective disorders and personality disorders. Further differences were found regarding frequency of Internet use regarding social networking sites and online-pornography. Discussion Patients with Internet addiction have a heightened probability for meeting criteria of bipolar disorders. It is not possible to draw conclusions regarding the direction of this association but it is recommended to implement screening for bipolar disorders in patients presenting with Internet addiction. Conclusion Similar to gambling disorder, it might prove necessary to subsume bipolar disorders as an exclusion criterion for the future criteria of Internet addiction. PMID:26132914

  10. Spontaneous dissociation of bipolar hip hemiarthroplasty in a patient with nerve palsy: A case report and review of the literature

    PubMed Central

    Yuenyongviwat, Varah; Iamthanaporn, Khanin; Hongnaparak, Theerawit

    2015-01-01

    Introduction Dislocation after bipolar hemiarthroplasty is a common complication but dissociation of the prosthesis is rare. There are some reports of bipolar hemiarthroplasty dissociation at the inner head and outer shell. However, there are limited reports on acute spontaneous dissociation of the head and neck at the taper interface in bipolar hemiarthroplasty. Presentation of case A 65-year-old female had cemented bipolar hemi hip replacement after fixation failure of a dynamic hip screw. She had left lower limb weakness for ten years after previous spinal surgery. At the sixth week of postoperation, the patient had dissociation of the components of the bipolar hemiarthroplasty at the femoral head and neck junction. The patient had open reduction and femoral head revision. There was no re-dislocation at one-year follow-up. Discussion Dissociation of bipolar hemiarthroplasty is a complex complication that can happen from the modularity of the implant. This condition requires operative treatment. The mechanism and cause of failure should be identified before the operation. Conclusion To prevent this condition, preoperative planning and proper techniques should be done as an index procedure. In the case of marked shortening of the limb after an operation in patients with lower limb muscle weakness, we hypothesize that early full weight bearing with immediate use of a shoe lift might help prevent this condition. PMID:26339788

  11. Pattern of pharmacotherapy by episode types for patients with bipolar disorders and its concordance with treatment guidelines.

    PubMed

    Baek, Ji Hyun; Ha, Kyooseob; Yatham, Lakshimi N; Chang, Jae Seung; Ha, Tae Hyon; Jeon, Hong Jin; Hong, Kyung Sue; Chang, Sung Man; Ahn, Yong Min; Cho, Hyun Sang; Moon, Eunsoo; Cha, Boseok; Choi, Jung Eun; Joo, Yeon Ho; Joo, Eun Jeong; Lee, Se Young; Park, Yunseong

    2014-10-01

    This study aimed to investigate the overall prescription pattern for patients with bipolar disorders in Korea and its relevance to the practice guidelines. Prescription records from all patients with bipolar I and II disorders who have been admitted or who started the outpatient treatment during the year of 2009 in 10 academic setting hospitals were reviewed. A total of 1447 patients with bipolar I and II disorders were included in this study. Longitudinal prescription patterns of inpatients and outpatients were analyzed by episode types and compared with the clinical practice guideline algorithms. In all phases, polypharmacy was chosen as an initial treatment strategy (>80%). The combination of mood stabilizer and atypical antipsychotics was the most favored. Antipsychotics were prescribed in more than 80% of subjects across all phases. The rate of antidepressant use ranged from 15% to 40%, and it was more frequently used in acute treatment and bipolar II subjects. The concordance rate of prescriptions for manic inpatients to the guidelines was higher and relatively more consistent (43.8%-48.7%) compared with that for depressive inpatients (18.6%-46.9%). Polypharmacy was the most common reason for nonconcordance. In Korean psychiatric academic setting, polypharmacy and atypical antipsychotics were prominently favored in the treatment of bipolar disorder, even with the lack of evidence of its superiority. More evidence is needed to establish suitable treatment strategies. In particular, the treatment strategy for acute bipolar depression awaits more consensuses. PMID:25006813

  12. Nutrition and Bipolar Depression.

    PubMed

    Beyer, John L; Payne, Martha E

    2016-03-01

    As with physical conditions, bipolar disorder is likely to be impacted by diet and nutrition. Patients with bipolar disorder have been noted to have relatively unhealthy diets, which may in part be the reason they also have an elevated risk of metabolic syndrome and obesity. An improvement in the quality of the diet should improve a bipolar patient's overall health risk profile, but it may also improve their psychiatric outcomes. New insights into biological dysfunctions that may be present in bipolar disorder have presented new theoretic frameworks for understanding the relationship between diet and bipolar disorder. PMID:26876319

  13. Bipolar dislocation of the clavicle.

    PubMed

    Jiang, Wei; Gao, Shu-Guang; Li, Yu-Sheng; Lei, Guang-Hua

    2012-11-01

    Bipolar dislocation of the clavicle at acromioclavicular and sternoclavicular joint is an uncommon traumatic injury. The conservative treatments adopted in the past is associated with redislocation dysfunction and deformity. A 41 years old lady with bipolar dislocation of right shoulder is treated surgically by open reduction and internal fixation by oblique T-plate at sternoclavicular joint and Kirschner wire stabilization at acromioclavicular joint. The patient showed satisfactory recovery with full range of motion of the right shoulder and normal muscular strength. The case reported in view of rarity and at 2 years followup. PMID:23325981

  14. Erythrocyte lithium efflux in bipolar patients and control subjects: the question of reproducibility.

    PubMed

    Werstiuk, E S; Rathbone, M P; Grof, P

    1984-10-01

    The reproducibility of in vitro erythrocyte lithium efflux and lithium efflux in the presence of selected membrane transport inhibitors (phloretin, ouabain, 4,4'-diisothiocyano-2,2'-disulphonic acid stilbene, and p-chloromercury-benzene sulphonate) was investigated in bipolar patients and age- and sex-matched control subjects. Efflux experiments were repeated three times in each patient-control pair within a period of 14 days. No differences were detected between patients and control subjects in any of the parameters measured. All components of lithium efflux showed wide day-to-day variation in the same subject in both patients and control subjects. Intersubject variability, however, was significantly greater than intrasubject variation. Since intraindividual variation of phloretin-inhibited lithium efflux was found to be considerable, and no real patient-control differences could be detected, the significance of this in vitro parameter in bipolar affective illness seems somewhat questionable and should be carefully reconsidered. The relevance of these findings to the putative cell membrane dysfunction in this disease is discussed. PMID:6097931

  15. Bipolar versus monopolar transurethral resection of the prostate for benign prostatic hyperplasia: safe in patients with high surgical risk

    PubMed Central

    Yang, Er J.; Li, Hao; Sun, Xin B.; Huang, Li; Wang, Li; Gong, Xiao X.; Yang, Yong

    2016-01-01

    Here, we compared the effects of bipolar and monopolar transurethral resection of the prostate (B-TURP, M-TURP) for treating elderly patients (≥75 years) with benign prostatic hyperplasia(BPH) who had internal comorbidities. Eligible BPH patients were aged ≥75 years and had at least one internal comorbidity. In this open-label, prospective trial, patients were assigned to B-TURP (n = 75) and M-TURP (n = 88) groups. Data on prostate volume (PV), urination, and time during perioperative period were compared; data associated with urination and complications at one year postoperatively were also compared. Finally, follow-up data were available for 68 and 81 patients in the B-TURP and M-TURP group, respectively. No deaths were recorded. Intraoperative bleeding was lower and irrigation time, indwelling catheter time, and hospital stay were shorter in the B-TURP group than in the M-TURP group (p < 0.001). No difference was observed with respect to operation time (p = 0.058). At one year after the operation, differences with respect to urination and complications were not significant. In conclusion, Short-term efficacy of B-TURP or M-TURP was satisfactory for elderly patients with BPH who had internal comorbidities. Besides, B-TURP is a more sensible choice because it has a lower prevalence of adverse effects. PMID:26892901

  16. Asymptomatic bacteriuria. Which patients should be treated?

    PubMed

    Zhanel, G G; Harding, G K; Guay, D R

    1990-07-01

    Asymptomatic bacteriuria is common in both the community nursing home and hospital settings. Few data, however, are available about the potential complications arising from asymptomatic bacteriuria (eg, the development of symptomatic infection and renal damage) for various patient populations and for various medical conditions. On the basis of data in the literature, we believe that neonates and preschool children with asymptomatic bacteriuria should be treated. Pregnant women and "nonelderly" (less than 60 years old) men should be treated. We do not think that school-age children, nonpregnant, nonelderly women, or elderly men and women need antimicrobial treatment if their urinary tracks are normal. In addition, antimicrobial treatment is recommended for patients with asymptomatic bacteriuria and abnormal urinary tracts and those undergoing clean intermittent catheterization, genitourinary manipulation, or instrumentation. Patients with long-term indwelling catheters should not be treated. The treatment of asymptomatic bacteriuria in patients with short-term indwelling catheters and those with ileal conduits is controversial. These treatment recommendations should not necessarily be accepted as the standards of practice, since treatment is often controversial due to the lack of published data describing the natural course of asymptomatic bacteriuria in various patient populations. PMID:2196024

  17. Early Maladaptive Schemas in Bipolar Disorder Patients With and Without Suicide Attempts.

    PubMed

    Nilsson, Kristine Kahr

    2016-03-01

    Patients with bipolar disorder (BD) are at an increased risk of attempted and completed suicide. To elucidate the beliefs and assumptions associated with suicidality in BD, the present study compared BD patients with and without a history of suicide attempt in terms of early maladaptive schemas (EMSs). The sample consisted of 49 remitted BD patients who completed the Young Schema Questionnaire-Short Version. Information on suicide attempts was obtained through interviews combined with medical records. Compared with BD patients without suicide attempts, the BD patients with suicide attempts scored significantly higher on 3 EMSs: social isolation, practical incompetence, and entitlement. The findings suggest that specific EMSs may be implicated in suicidal behaviors in BD. These results have implications for the assessment and treatment of suicidality in BD. PMID:26919302

  18. Mobile-supported life charting for bipolar patients - user requirements study.

    PubMed

    Andersen, Per-Øivin Berg; Babic, Ankica

    2013-01-01

    It is assumed that bipolar disorder patients can benefit from monitoring their mood, sleep, medicine intake and behavior which could be both done by patients themselves and in cooperation with health care professionals. This study aims at understanding what is required from a computerized system, as seen from the view of therapists and the patients, and how the newer mobile technologies (smart phones and tablets) can be utilized to support development of such a system. The study focuses on several existing solutions available either freely or on the market. Then these solutions are evaluated by both patients and medical professionals as a part of the system requirements study to be used in a new system development that will utilize mobile technologies to support the performance and patient outcomes. PMID:23920885

  19. The Relationship Between Educational Years and Phonemic Verbal Fluency (PVF) and Semantic Verbal Fluency (SVF) Tasks in Spanish Patients Diagnosed With Schizophrenia, Bipolar Disorder, and Psychotic Bipolar Disorder

    PubMed Central

    García-Laredo, Eduardo; Maestú, Fernando; Castellanos, Miguel Ángel; Molina, Juan D.; Peréz-Moreno, Elisa

    2015-01-01

    Abstract Semantic and verbal fluency tasks are widely used as a measure of frontal capacities. It has been well described in literature that patients affected by schizophrenic and bipolar disorders present a worse execution in these tasks. Some authors have also noted the importance of educational years. Our objective is to analyze whether the effect of cognitive malfunction caused by apathology is superior to the expected effect of years of education in phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) task execution. A total of 62 individuals took part in this study, out of which 23 were patients with schizophrenic paranoid disorder, 11 suffered from bipolar disorder with psychotic symptomatology, 13 suffered from bipolar disorder without psychotic symptomatology, and 15 participants were nonpathological individuals. All participants were evaluated with the PVF and SVF tests (animals and tools). The performance/execution results were analyzed with a mixed-model ANCOVA, with educational years as a covariable. The effect of education seems to be more determined by PVF FAS tests than by SVF. With PVF FAS tasks, the expected effect of pathology disappears when the covariable EDUCATION is introduced. With SVF tasks, the effect continues to be significant, even though the EDUACTION covariable dims such effect. These results suggest that SVF tests (animals category) are better evaluation tools as they are less dependent on the patients’ education than PVF FAS tests. PMID:26426640

  20. Neuropsychology, social cognition and global functioning among bipolar, schizophrenic patients and healthy controls: preliminary data

    PubMed Central

    Caletti, Elisabetta; Paoli, Riccardo A.; Fiorentini, Alessio; Cigliobianco, Michela; Zugno, Elisa; Serati, Marta; Orsenigo, Giulia; Grillo, Paolo; Zago, Stefano; Caldiroli, Alice; Prunas, Cecilia; Giusti, Francesca; Consonni, Dario; Altamura, A. Carlo

    2013-01-01

    This study aimed to determine the extent of impairment in social and non-social cognitive domains in an ecological context comparing bipolar (BD), schizophrenic (SKZ) patients and healthy controls (HC). The sample was enrolled at the Department of Psychiatry of Policlinico Hospital, University of Milan; it includes stabilized SKZ patients (n = 30), euthymic bipolar patients (n = 18) and HC (n = 18). Patients and controls completed psychiatric assessment rating scales, the Brief Assessment of Cognition in Schizophrenia (BACS) and the Executive and Social Cognition Battery (ESCB) that contains both ecological tests of executive function and social cognition, in order to better detect cognitive deficits in patients with normal results in standard executive batteries. The three groups differed significantly for gender and substance abuse, however, the differences did not influence the results. BD patients showed less impairment on cognitive performance compared to SKZ patients, even in “ecological” tests that mimic real life scenarios. In particular, BD performed better than SKZ in verbal memory (p < 0.0038) and BACS symbol coding (p < 0.0043). Regarding the ESCB tests, in the Hotel task SKZ patients completed significantly less tasks (p < 0.001), showed a greater number of errors in Multiple Errands Test (MET-HV) (p < 0.0248) and a worse performance in Theory of Mind (ToM) tests (p < 0.001 for the Eyes test and Faux pas test). Both patients' groups performed significantly worse than HC. Finally, significant differences were found between the two groups in GAF scores, being greater among BD subjects (p < 0.001). GAF was correlated with BACS and ESCB scores showing the crucial role of cognitive and ecological performances in patients' global functioning. PMID:24146642

  1. Poor Sleep at Baseline Predicts Worse Mood Outcomes in Patients with Co-Occurring Bipolar Disorder and Substance Dependence

    PubMed Central

    Putnins, Susan I.; Griffin, Margaret L.; Fitzmaurice, Garrett M.; Dodd, Dorian R.; Weiss, Roger D.

    2011-01-01

    Objective Sleep problems are common to patients with bipolar disorder and have been shown to predict subsequent mood symptoms, and have also been shown to lead to worse substance use outcomes in those with substance use disorders. However, the relationship between sleep and clinical outcomes in a population with co-occurring bipolar disorder and substance use disorder is unclear. Method 60 outpatients meeting DSM-IV (SCID) criteria for both bipolar disorder and substance use disorder participated in a randomized trial comparing integrated group therapy for bipolar disorder and substance use disorder to group drug counseling for substance use disorder alone. Poor sleep was assessed with the Pittsburgh Sleep Quality Index, which provides 7 component subscores and an overall sleep score. Results When controlling for baseline mood, substance use, and treatment condition, baseline sleep score predicted mood over the course of treatment and the 6-month follow-up: worse sleep was associated with worse mood outcomes. Sleep was not associated with substance use outcomes. Conclusion Impaired sleep is a prognostic factor for mood outcomes in patients with co-occurring bipolar and substance use disorders. Further investigation is warranted into the long-term clinical outcomes of poor sleep in this population with co-occurring bipolar disorder and substance use disorder so that appropriate interventions can be developed. This clinical trial has been registered in a public trials registry at clinicaltrials.gov (identifier is NCT00227838). PMID:22313797

  2. [Changes in prescription patterns to patients with bipolar syndromes. Increased use of lamotrigine and decreased use of lithium].

    PubMed

    Karanti, Alina; Kardell, Mathias; Lundberg, Ulrika; Landén, Mikael

    Lithium is a first line option in the maintenance treatment of bipolar disorder, but several alternative treatment regimens have been introduced in recent years, among them treatment with antiepileptic compounds and atypical antipsychotic drugs. Little is known about if and how this has changed the prescription patterns of mood stabilizers. We analysed trends in prescription of mood stabilisers in Sweden using the national quality register for bipolar disorder (BipoläR), the Prescribed Drug Register, and the Patient Register during the years 2007-2011. We found that lithium use decreased while lamotrigine use increased in bipolar patients. These changes could not be ex-plained by differences in bipolar subtypes; lithium use decreased in both bipolar type I and type II, and the use of lamotrigine increased in bipolar type II. Lithium use was more common in men, whereas lamotrigine use was more common in women. The prescription of other mood stabilisers did not change during these years.  PMID:25514669

  3. Affective temperaments and psychopathological dimensions of personality in bipolar and cyclothymic patients.

    PubMed

    Harnic, Désirée; Pompili, Maurizio; Mazza, Marianna; Innamorati, Marco; Di Nicola, Marco; Catalano, Valeria; Bruschi, Angelo; Del Bono, Diletta; Forte, Alberto; Lester, David; Girardi, Paolo; Bria, Pietro; Janiri, Luigi

    2013-01-01

    The aims of the study were: (1) to study possible associations between temperament, personality dimensions, and psychopathological variables in a clinical sample of euthymic patients with bipolar disorder (BD) and cyclothymia; and (2) to assess how Cloninger's temperament and personality dimensions were associated with affective temperaments. Participants, consisting of 60 patients with BD (type I or II) and cyclothymia in the euthymic phase, completed Akiskal's Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A), and Cloninger's Temperament and Character Inventory-revised version (TCI-R). The diagnostic groups differed in past hospitalization, for age at onset of the disorder, and on two affective temperaments: the TEMPS-A Hyperthymia, and the TEMPS-A Irritability. There were six significant associations between affective temperaments and Cloninger's personality dimensions, ranging from 0.26 to 0.54. The measures of Akiskal and of Cloninger tap common behavioral features in patients with bipolar disorder and cyclothymia, yet the differences indicate that the two measures are not redundant. BD and cyclothymic patients differed significantly in temperament and personality, differences that may have important implications for treatment. PMID:23398272

  4. Psychosocial Functioning in Depressive Patients: A Comparative Study between Major Depressive Disorder and Bipolar Affective Disorder

    PubMed Central

    Mittal, Pankaj Kumar; Swami, Mukesh Kumar

    2014-01-01

    Introduction. Major depressive disorder (MDD) and bipolar affective disorder (BAD) are among the leading causes of disability. These are often associated with widespread impairments in all domains of functioning including relational, occupational, and social. The main aim of the study was to examine and compare nature and extent of psychosocial impairment of patients with MDD and BAD during depressive phase. Methodology. 96 patients (48 in MDD group and 48 in BAD group) were included in the study. Patients were recruited in depressive phase (moderate to severe depression). Patients having age outside 18–45 years, psychotic symptoms, mental retardation, and current comorbid medical or axis-1 psychiatric disorder were excluded. Psychosocial functioning was assessed using Range of Impaired Functioning Tool (LIFE-RIFT). Results. Domains of work, interpersonal relationship, life satisfaction, and recreation were all affected in both groups, but the groups showed significant difference in global psychosocial functioning score only (P = 0.031) with BAD group showing more severe impairment. Conclusion. Bipolar depression causes higher global psychosocial impairment than unipolar depression. PMID:24744917

  5. Bipolar Disorder

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Bipolar Disorder KidsHealth > For Teens > Bipolar Disorder Print A A ... Bipolar Disorder en español Trastorno bipolar What Is Bipolar Disorder? Bipolar disorders are one of several medical conditions ...

  6. Recognizing and treating patients with envenomations.

    PubMed

    Hurt, John B; Maday, Kristopher R

    2016-07-01

    Venomous spiders and snakes are found throughout the United States, and clinicians often encounter patients with suspected spider or snakebites. Due to the significant morbidity and mortality that can be related to a particular envenomation, clinicians must be able to recognize the species of spiders and snakes that are capable of delivering a venomous bite. Through proper species identification, recognition of the specific signs and symptoms that specific venom produces, and understanding the treatment guidelines for the envenomation, clinicians can properly diagnosis, treat, and manage patients with venomous bites. PMID:27351646

  7. Disease signatures for schizophrenia and bipolar disorder using patient-derived induced pluripotent stem cells.

    PubMed

    Watmuff, Bradley; Berkovitch, Shaunna S; Huang, Joanne H; Iaconelli, Jonathan; Toffel, Steven; Karmacharya, Rakesh

    2016-06-01

    Schizophrenia and bipolar disorder are complex psychiatric disorders that present unique challenges in the study of disease biology. There are no objective biological phenotypes for these disorders, which are characterized by complex genetics and prominent roles for gene-environment interactions. The study of the neurobiology underlying these severe psychiatric disorders has been hindered by the lack of access to the tissue of interest - neurons from patients. The advent of reprogramming methods that enable generation of induced pluripotent stem cells (iPSCs) from patient fibroblasts and peripheral blood mononuclear cells has opened possibilities for new approaches to study relevant disease biology using iPSC-derived neurons. While early studies with patient iPSCs have led to promising and intriguing leads, significant hurdles remain in our attempts to capture the complexity of these disorders in vitro. We present here an overview of studies to date of schizophrenia and bipolar disorder using iPSC-derived neuronal cells and discuss potential future directions that can result in the identification of robust and valid cellular phenotypes that in turn can lay the groundwork for meaningful clinical advances. PMID:26777134

  8. The borderline of bipolar: opinions of patients and lessons for clinicians on the diagnostic conflict

    PubMed Central

    Richardson, Emma; Tracy, Derek K.

    2015-01-01

    Aims and method It has been observed that some individuals self-diagnose with a bipolar affective disorder and many are later diagnosed with a borderline personality disorder. There is a background context of clinical and neurobiological overlap between these conditions, and fundamental debates on the validity of current diagnostic systems. This qualitative study is the first work to explore the views of patients caught at this diagnostic interface. We predicted that media exposure, stigma and attribution of responsibility would be key factors affecting patient understanding and opinion. Results Six core illness-differentiating themes emerged: public information, diagnosis delivery, illness causes, illness management, stigma, and relationship with others. Individuals did not ‘want’ to be diagnosed with a bipolar disorder, but wished for informed care. Clinical implications Understanding patient perspectives will allow clinical staff to better appreciate the difficulties faced by those we seek to help, identify gaps in care provision, and should stimulate thought on our attitudes to care and how we facilitate provision of information, including information about diagnosis. PMID:26191447

  9. Fractal analysis of MRI data for the characterization of patients with schizophrenia and bipolar disorder

    NASA Astrophysics Data System (ADS)

    Squarcina, Letizia; De Luca, Alberto; Bellani, Marcella; Brambilla, Paolo; Turkheimer, Federico E.; Bertoldo, Alessandra

    2015-02-01

    Fractal geometry can be used to analyze shape and patterns in brain images. With this study we use fractals to analyze T1 data of patients affected by schizophrenia or bipolar disorder, with the aim of distinguishing between healthy and pathological brains using the complexity of brain structure, in particular of grey matter, as a marker of disease. 39 healthy volunteers, 25 subjects affected by schizophrenia and 11 patients affected by bipolar disorder underwent an MRI session. We evaluated fractal dimension of the brain cortex and its substructures, calculated with an algorithm based on the box-count algorithm. We modified this algorithm, with the aim of avoiding the segmentation processing step and using all the information stored in the image grey levels. Moreover, to increase sensitivity to local structural changes, we computed a value of fractal dimension for each slice of the brain or of the particular structure. To have reference values in comparing healthy subjects with patients, we built a template by averaging fractal dimension values of the healthy volunteers data. Standard deviation was evaluated and used to create a confidence interval. We also performed a slice by slice t-test to assess the difference at slice level between the three groups. Consistent average fractal dimension values were found across all the structures in healthy controls, while in the pathological groups we found consistent differences, indicating a change in brain and structures complexity induced by these disorders.

  10. Fractal analysis of MRI data for the characterization of patients with schizophrenia and bipolar disorder.

    PubMed

    Squarcina, Letizia; De Luca, Alberto; Bellani, Marcella; Brambilla, Paolo; Turkheimer, Federico E; Bertoldo, Alessandra

    2015-02-21

    Fractal geometry can be used to analyze shape and patterns in brain images. With this study we use fractals to analyze T1 data of patients affected by schizophrenia or bipolar disorder, with the aim of distinguishing between healthy and pathological brains using the complexity of brain structure, in particular of grey matter, as a marker of disease. 39 healthy volunteers, 25 subjects affected by schizophrenia and 11 patients affected by bipolar disorder underwent an MRI session. We evaluated fractal dimension of the brain cortex and its substructures, calculated with an algorithm based on the box-count algorithm. We modified this algorithm, with the aim of avoiding the segmentation processing step and using all the information stored in the image grey levels. Moreover, to increase sensitivity to local structural changes, we computed a value of fractal dimension for each slice of the brain or of the particular structure. To have reference values in comparing healthy subjects with patients, we built a template by averaging fractal dimension values of the healthy volunteers data. Standard deviation was evaluated and used to create a confidence interval. We also performed a slice by slice t-test to assess the difference at slice level between the three groups. Consistent average fractal dimension values were found across all the structures in healthy controls, while in the pathological groups we found consistent differences, indicating a change in brain and structures complexity induced by these disorders. PMID:25633275

  11. Electrophysiological correlates of bilateral and unilateral repetitive transcranial magnetic stimulation in patients with bipolar depression.

    PubMed

    Kazemi, Reza; Rostami, Reza; Khomami, Sanaz; Horacek, Jiri; Brunovsky, Martin; Novak, Tomas; Fitzgerald, Paul B

    2016-06-30

    Repetitive transcranial magnetic stimulation (rTMS) has been demonstrated to have efficacy in the treatment of unipolar depression but limited research has explored the efficacy of rTMS in bipolar depression. Therefore, we conducted a comparative clinical trial evaluating clinical responses to prefrontal bilateral and unilateral rTMS in patients suffering from bipolar depression. We hypothesized that, 1) the response to the treatment would be associated with a decrease in the frequency of beta waves, 2) bilateral stimulation of the cortex would bring about more extensive changes in brain activity than unilateral stimulation, and 3) bilateral stimulation is more effective than unilateral. Thirty patients with bipolar depression were divided into two groups. Bilateral Group (n=15) who received rTMS in the left DLPFC (10Hz) and right DLPFC (1-Hz), and unilateral group (n=15) who received the stimulation only in the right DLPFC (1-Hz) during 20 treatment sessions. The proportion of responders in the bilateral stimulation group was significantly higher than that in the unilateral group [80% versus 47%]. The remission rate was 40% in the bilateral group and 40% in the unilateral group (not significant). In the responders to bilateral rTMS treatment, a significant reduction of alpha1-2, beta 1-3, and gamma frequencies were observed in medial and superior frontal and cingulate gyrus . Responders to the unilateral treatment showed decrease of gamma frequency in postcentral gyrus, precuneus, superior and inferior parietal lobule, Cuneus and angular gyrus. In conclusion, we found that bilateral stimulation was more effective than the unilateral stimulation and evidence that beta frequency activity could possibly be used as a marker for response to rTMS. PMID:27138833

  12. P300 component in euthymic patients with bipolar disorder type I, bipolar disorder type II and healthy controls: a preliminary event-related potential study.

    PubMed

    Bersani, Francesco S; Minichino, Amedeo; Fattapposta, Francesco; Mannarelli, Daniela; Pauletti, Caterina; Imperatori, Claudio; Spagnoli, Francesco; Biondi, Massimo; Delle Chiaie, Roberto

    2015-03-01

    The aim of the present study was to investigate P300 event-related potential components in euthymic bipolar disorder type I (BDI) and bipolar disorder type II (BDII) patients and matched controls. A total of 10 BDI patients, 10 BDII patients and 10 healthy individuals were enrolled in the study. Event-related potential data were collected according to a standard auditory 'oddball' paradigm. A significant groups effect in both the peak amplitude (P<0.001) and the mean amplitude (P<0.001) was observed; post-hoc comparisons showed that the peak and mean amplitudes of BDI and BDII patients were significantly lower than the peak and mean amplitudes of the healthy controls. The neurophysiological patterns found in the present study might at least partially reflect the presence of a mild selective cognitive impairment in euthymic BDI and BDII patients. From a clinical point of view, these evidences support the potential role of cognitive interventions in the treatment of BD. PMID:25674905

  13. How I treat glioblastoma in older patients.

    PubMed

    Mohile, Nimish A

    2016-01-01

    Glioblastoma, a WHO grade IV astrocytoma, is the most common primary malignant brain tumor in adults. It is characterized by molecular heterogeneity and aggressive behavior. Glioblastoma is almost always incurable and most older patients survive less than 6 months. Supportive care with steroids and anti-epileptic drugs is critical to improving and maintain quality of life. Young age, good performance status and methylation of the methyl guanyl methyl transferase promoter are important positive prognostic factors. Several recent clinical trials suggest that there is a subset of the elderly with prolonged survival that is comparable to younger patients. Treatment of glioblastoma in older patients includes maximal safe resection followed by either radiation, chemotherapy or combined modality therapy. Recent advances suggest that some patients can avoid radiation entirely and be treated with chemotherapy alone. Decisions about therapy are individual and based on a patient's performance status, family support and molecular features. Future work needs to better determine the role for comprehensive geriatric assessments in this patient population to better identify patients who may most benefit from aggressive therapies. PMID:26725536

  14. Management of inter-episodic periods in patients with bipolar disorder.

    PubMed

    Samalin, Ludovic; Murru, Andrea; Vieta, Eduard

    2016-06-01

    The management of inter-episodic periods of bipolar disorder (BD) appears complex as it combines several therapeutic approaches and takes into account individual characteristics of BD patients. Over recent decades, new evidence has been provided about pharmacological treatments, psychosocial interventions or models of care for the long-term management of BD patients. Considering this, guidelines for the maintenance treatment of BD should be regarded as an evidence-based ground for everyday clinical practice in real-life setting. This article critically reviews recently published clinical guidelines on the management of BD patients during the inter-episodic phases of illness, in order to highlight the consensual or controversial recommendations. PMID:27058008

  15. Emotion Regulation Strategies Can Predict Task-Switching Abilities in Euthymic Bipolar Patients

    PubMed Central

    Gul, Amara; Khan, Kamran

    2014-01-01

    This study examined task-switching abilities and emotion regulation strategies in euthymic bipolar patients (EBP). Forty EBP and 40 healthy individuals performed face categorization tasks where they switched between emotion and non-emotion (i.e., gender) features among faces and completed emotion regulation questionnaire (Gross and John, 2003). Subject groups showed substantial differences in task-switching abilities and emotion regulation strategies: (1) there was a dissociation between emotion and gender classification in EBP. The switch cost was larger [i.e., higher reaction times (RTs) on switch as compared to no-switch trials] for gender categorization as compared to the emotion categorization task. In contrast, such asymmetries were absent among healthy participants. The differential pattern of task switching reflected functional disturbances in frontotemporal neural system and an attentional bias to emotion features of the faces in EBP. This suggests that when a euthymic bipolar patient is preoccupied with emotion recognition, an instruction to perform gender categorization results in greater cost on RTs. (2) In contrast to healthy individuals, EBP reported more frequent use of emotion suppression and lesser use of cognitive reappraisal as emotion regulation strategy. (3) Emotion regulation was found to be a significant predictor of task-switching abilities. It is argued that task switching deficits rely on maladaptive emotion regulation strategies in EBP specifically when tasks of emotional significance are involved. PMID:25386129

  16. Cognitive function in euthymic bipolar disorder (BP I) patients with a history of psychotic symptoms vs. schizophrenia.

    PubMed

    Nenadic, Igor; Langbein, Kerstin; Dietzek, Maren; Forberg, Anne; Smesny, Stefan; Sauer, Heinrich

    2015-11-30

    Patients with bipolar disorder show cognitive deficits including executive function, which appear to be related to social functioning and outcome. However, subgroups within the spectrum as well as psychopathological features, current mood state/euthymia and disease stage might be confounding factors. We analysed data tests from the Wechsler Intelligence Scale (WIE), verbal fluency (COWA) and trail making tests (TMT-A and TMT-B) obtained in a selected subgroup of currently bipolar I disorder patients, who were currently euthymic and had a history of psychotic symptoms, and compared them to patients with schizophrenia (in remission) and healthy controls, all matched for age, gender, and handedness. Schizophrenia patients showed more severe cognitive impairment, including digit symbol and arithmetic tests, as well as TMT-B (compared to healthy controls), but bipolar patients had stronger impairment on the letter number sequencing test, an indicator of working memory and processing speed. There were no group effects on most verbal fluency tasks (except impairment of schizophrenia patients on one subscale of category fluency). Within the limitations of the study design, our results suggest that even in subgroups of presumably more severely impaired bipolar patients, some cognitive dimensions might achieve remission, possibly related to considerable state effects at testing. PMID:26319738

  17. Platelet dysfunction in vincristine treated patients.

    PubMed

    Steinherz, P G; Miller, D R; Hilgartner, M W; Schmalzer, E A

    1976-03-01

    Recent revival of interest in the use of vincristine (VCR) for the treatment of idiopathic thrombocytopenic purpura prompted us to evaluate the platelet function of our patients on VCR. Eighteen patients with acute lymphoblastic leukaemia (ALL) in remission, and nine children with solid tumours were studied on 80 occasions at different time intervals after their last VCR dose. A mildly elevated threshold for epinephrine-induced second phase aggregation and a delay in the onset of collagen-induced aggregation was found in patients with ALL not on VCR. Vincristine induced unobtainable second phase aggregation to epinephrine in 67%, 38%, 30% and to ADP in 53%, 13%, 33% of the patients 1 week, 2-3 weeks and 4 weeks respectively after administration. The thrombocytopathy was relative, not absolute, since collagen induced aggregation at all times. Platelet counts, uptake and release of serotonin, bleeding times, clot retractions and release of platelet factor 3 were normal. Platelet adhesion was abnormal in five of 12 patients tested. In vitro platelets are a hundred-fold less sensitive to VCR than in vivo. Cyclic adenosine monophosphate, cyclic guanosine monophosphate and dimethylsulfoxide do not protect platelets from VCR. The exact mechanism by which VCR abolishes second phase aggregation in patients is uncertain. Because of VCR's narrow therapeutic index between thrombocytopenia and thrombocythaemia, the use of VCR should be reserved for life-threatening haematologic disorders when treating non-malignant conditions. PMID:175822

  18. Cortical thickness, volume and surface area in patients with bipolar disorder types I and II

    PubMed Central

    Abé, Christoph; Ekman, Carl-Johan; Sellgren, Carl; Petrovic, Predrag; Ingvar, Martin; Landén, Mikael

    2016-01-01

    Background Bipolar disorder (BD) is a common chronic psychiatric disorder mainly characterized by episodes of mania, hypomania and depression. The disorder is associated with cognitive impairments and structural brain abnormalities, such as lower cortical volumes in primarily frontal brain regions than healthy controls. Although bipolar disorder types I (BDI) and II (BDII) exhibit different symptoms and severity, previous studies have focused on BDI. Furthermore, the most frequently investigated measure in this population is cortical volume. The aim of our study was to investigate abnormalities in patients with BDI and BDII by simultaneously analyzing cortical volume, thickness and surface area, which yields more information about disease- and symptom-related neurobiology. Methods We used MRI to measure cortical volume, thickness and area in patients with BDI and BDII as well as in healthy controls. The large study cohort enabled us to adjust for important confounding factors. Results We included 81 patients with BDI, 59 with BDII and 85 controls in our analyses. Cortical volume, thickness and surface area abnormalities were present in frontal, temporal and medial occipital regions in patients with BD. Lithium and antiepileptic drug use had an effect on the observed differences in medial occipital regions. Patients with the subtypes BDI and BDII displayed common cortical abnormalities, such as lower volume, thickness and surface area than healthy controls in frontal brain regions but differed in temporal and medial prefrontal regions, where only those with BDI had abnormally low cortical volume and thickness. Limitations The group differences can be explained by progressive changes, but also by premorbid conditions. They could also have been influenced by unknown factors, such as social, environmental or genetic factors. Conclusion Our findings suggest diagnosis-related neurobiological differences between the BD subtypes, which could explain distinct symptoms and

  19. Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants

    PubMed Central

    Li, Dian-Jeng; Tseng, Ping-Tao; Chen, Yen-Wen; Wu, Ching-Kuan; Lin, Pao-Yen

    2016-01-01

    Abstract Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis. Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants. We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other

  20. Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders.

    PubMed

    Hsu, Yi-Chao; Hsu, Chih-Chao; Chang, Kuang-Hsi; Lee, Chang-Yin; Chong, Lee-Won; Wang, Yu-Chiao; Kao, Chia-Hung

    2015-07-01

    Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43-1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted. PMID:26200637

  1. Increased Subsequent Risk of Peptic Ulcer Diseases in Patients With Bipolar Disorders

    PubMed Central

    Hsu, Yi-Chao; Hsu, Chih-Chao; Chang, Kuang-Hsi; Lee, Chang-Yin; Chong, Lee-Won; Wang, Yu-Chiao; Kao, Chia-Hung

    2015-01-01

    Abstract Previous studies have reported that patients with bipolar disorders (BDs) exhibit increased physical comorbidity and psychological distress. Studies have shown that schizophrenia and anxiety increase the risk of peptic ulcer diseases (PUDs). Therefore, we conducted this study to determine the association between these 2 diseases and examine the possible risk factors. We used patients diagnosed with BDs from the Taiwan National Health Insurance Research Database. A comparison cohort comprising patients without BDs was frequency matched by age, sex, and comorbidities, and the occurrence of PUDs was evaluated in both the cohorts. The BD and non-BD cohort consisted of 21,060 patients with BDs and 84,240 frequency-matched patients without BDs, respectively. The incidence of PUDs (hazard ratio, 1.51; 95% confidence interval, 1.43–1.59; P < 0.001) was higher among the patients with BDs than the control patients. Cox models showed that irrespective of comorbidities, BDs were an independent risk factor for PUDs. Patients with BDs exhibit a substantially higher risk for developing PUDs. According to our data, we suggest that, following a diagnosis of BD, practitioners could notice the occurrence of PUD and associated prevention. Further prospective clinical studies investigating the relationship between BDs and PUDs are warranted. PMID:26200637

  2. Concomitant neuroleptic malignant syndrome and lithium intoxication in a patient with bipolar I disorder: case report.

    PubMed

    Lin, P Y; Wu, C K; Sun, T F

    2000-10-01

    The purpose of this report is to remind clinicians of the risk of the simultaneous occurrence of neuroleptic malignant syndrome (NMS) and lithium intoxication. A 39-year-old female with bipolar I disorder was admitted to our psychiatric ward due to relapse of a manic episode and a suicide attempt in which she had ingested 20 to 30 tablets of lithium (300 mg/tablet) 12 hours before admission. Except for intramuscular injection of 5 mg of haloperidol 30 minutes after admission, the patient received no antipsychotic drugs during her hospitalization. Six hours after admission, she began to show symptoms of NMS. Lithium intoxication was also found. Within a week, her condition had stabilized with no neurological complications or cognitive deficits noted during the following 4 months. Discussed in this case report are the risk factors of NMS found in this patient, drug interactions of lithium and antipsychotic agents as related to NMS, and problems in clinical management. PMID:11126155

  3. A Network Approach to Bipolar Symptomatology in Patients with Different Course Types

    PubMed Central

    Koenders, M. A.; de Kleijn, R.; Giltay, E. J.; Elzinga, B. M.; Spinhoven, P.; Spijker, A. T.

    2015-01-01

    Objective The longitudinal mood course is highly variable among patients with bipolar disorder(BD). One of the strongest predictors of the future disease course is the past disease course, implying that the vulnerability for developing a specific pattern of symptoms is rather consistent over time. We therefore investigated whether BD patients with different longitudinal course types have symptom correlation networks with typical characteristics. To this end we used network analysis, a rather novel approach in the field of psychiatry. Method Based on two-year monthly life charts, 125 patients with complete 2 year data were categorized into three groups: i.e., a minimally impaired (n = 47), a predominantly depressed (n = 42) and a cycling course (n = 36). Associations between symptoms were defined as the groupwise Spearman’s rank correlation coefficient between each pair of items of the Young Mania Rating Scale (YMRS) and the Quick Inventory of Depressive Symptomatology (QIDS). Weighted symptom networks and centrality measures were compared among the three groups. Results The weighted networks significantly differed among the three groups, with manic and depressed symptoms being most strongly interconnected in the cycling group. The symptoms with top centrality that were most interconnected also differed among the course group; central symptoms in the stable group were elevated mood and increased speech, in the depressed group loss of self-esteem and psychomotor slowness, and in the cycling group concentration loss and suicidality. Conclusion Symptom networks based on the timepoints with most severe symptoms of bipolar patients with different longitudinal course types are significantly different. The clinical interpretation of this finding and its implications are discussed. PMID:26505477

  4. Investigating Aggressive Styles and Defense Mechanisms in Bipolar Patients and in their Parents.

    PubMed

    Bragazzi, Nicola Luigi; Pezzoni, Franca; Del Puente, Giovanni

    2014-11-01

    Bipolar disorder (BD) is a very common mental health disorder, whose etiology concerning aggressive styles and defense mechanisms is still poorly known despite the efforts dedicated to develop psychological and biological theories. After obtaining written signed informed consent, this study will recruit inpatients with a clinical diagnosis of BD, based on Structured Clinical Interview and the Diagnostic and Statistical Manual of Mental Disorders criteria, and their parents. The Bus-Perry Aggression Questionnaire, the Defense Style Questionnaire 40, the Symptom check list SCL-90-R, developed by DeRogatis will be administered to the participants, together with a semi-structured questionnaire concerning demographic data (age, gender, employment, education) and only for the patients clinical information (onset year of the disorder, presence of co-morbidities, alcohol and drug use, suicide tendencies, kind of treatment). All the questionnaires are in the Italian validated version. The successful completion of this study will shed light on the relationship between aggressive styles and defensive mechanisms in bipolar inpatients and in their parents, helping the clinicians to develop ad hoc psychological interventions. PMID:26973942

  5. Investigating the underlying mechanisms of aberrant behaviors in bipolar disorder from patients to models: Rodent and human studies.

    PubMed

    van Enkhuizen, Jordy; Geyer, Mark A; Minassian, Arpi; Perry, William; Henry, Brook L; Young, Jared W

    2015-11-01

    Psychiatric patients with bipolar disorder suffer from states of depression and mania, during which a variety of symptoms are present. Current treatments are limited and neurocognitive deficits in particular often remain untreated. Targeted therapies based on the biological mechanisms of bipolar disorder could fill this gap and benefit patients and their families. Developing targeted therapies would benefit from appropriate animal models which are challenging to establish, but remain a vital tool. In this review, we summarize approaches to create a valid model relevant to bipolar disorder. We focus on studies that use translational tests of multivariate exploratory behavior, sensorimotor gating, decision-making under risk, and attentional functioning to discover profiles that are consistent between patients and rodent models. Using this battery of translational tests, similar behavior profiles in bipolar mania patients and mice with reduced dopamine transporter activity have been identified. Future investigations should combine other animal models that are biologically relevant to the neuropsychiatric disorder with translational behavioral assessment as outlined here. This methodology can be utilized to develop novel targeted therapies that relieve symptoms for more patients without common side effects caused by current treatments. PMID:26297513

  6. Evaluating depressive symptoms in mania: a naturalistic study of patients with bipolar disorder

    PubMed Central

    Young, Allan H; Eberhard, Jonas

    2015-01-01

    Objective This study aimed to evaluate patients with bipolar I disorder (BD-I) who have mania with depressive symptoms and who meet the new “with mixed features” specifier of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). Method This prospective, multinational, naturalistic study surveyed psychiatrists and their patients with BD-I from October 2013 to March 2014. Eligible patients had BD-I, had a (current) manic episode, and had experienced onset of a manic episode within the previous 3 months. Psychiatrists provided patient information on depressive symptoms (DSM-5 criteria); symptoms of anxiety, irritability, and agitation; suicide attempts; and physician satisfaction with treatment response. Data were stratified according to whether patients met the criteria for the BD-I “with mixed features” specifier of DSM-5 (≥3 depressive symptoms) or not, and characteristics were compared between the two subgroups. Patients also self-reported on depressive symptoms using the Mini-International Neuropsychiatric Interview module questionnaire. Results Overall, 34% of 1,035 patients met the criteria for BD-I “with mixed features,” exhibiting ≥3 depressive symptoms during their current manic episode. This correlated with the matched patient self-reports of depressive symptoms. During their current manic episode, BD-I patients “with mixed features” had more severe symptoms of anxiety, irritability, and agitation (average composite severity score of 4.1 vs 3.4), a higher incidence of suicide attempts (38% vs 9%), and more physician dissatisfaction with treatment response (22% vs 14%), compared to patients with 0–2 depressive symptoms (all P<0.05). Conclusion This study found that patients with BD-I “with mixed features” (ie, ≥3 depressive symptoms during a manic episode), suffered, on average, from a greater burden of disease than patients with pure mania. Improved identification of these patients may help to optimize

  7. Reduced Fertility and Fecundity among Patients with Bipolar I Disorder and Schizophrenia in Egypt

    PubMed Central

    Mansour, Hader; Kandil, Kareem; Wood, Joel; Fathi, Warda; Elassy, Mai; Ibrahim, Ibtihal; Salah, Hala; Yassin, Amal; Elsayed, Hanan; Tobar, Salwa; El-Boraie, Hala; Eissa, Ahmed; Elhadidy, Mohamed; Ibrahim, Nahed E.; El-Bahaei, Wafaa

    2011-01-01

    Objective To evaluate reproduction among patients with bipolar I disorder (BP1) or schizophrenia (SZ) in Egypt. Methods BP1 patients (n=113) were compared with community based, demographically balanced controls (n=124) and SZ patients (n=79, DSM-IV). All participants were evaluated using structured interviews and corroborative data were obtained from relatives. Standard indices of procreation were included in multivariate analyses that incorporated key demographic variables. Results Control individuals were significantly more likely to have children than BP1 or SZ patients (controls 46.8%, BP1 15.9%, SZ 17.7%), but the BP1-SZ differences were non-significant. The average number of children for BP1 patients (0.37±0.9) and SZ patients (0.38±0.9) was significantly lower than for controls (1.04±1.48) (BP1 vs controls, p<0.001; SZ vs controls, p<0.001). The frequency of marriages among BP1 patients was nominally higher than the SZ group, but was significantly lower than controls (BP1: 31.9% SZ: 27.8% control: 57.3%). Even among married individuals, BP1 (but not SZ) patients were childless more often than controls (p=0.001). The marital fertility, i.e., the average number of children among patients with conjugal relationships for controls (1.8±1.57) was significantly higher than BP1 patients (1.14±1.31, p=0.02), but not significantly different from SZ patients (1.36±1.32, p=0.2). Conclusion Selected reproductive measures are significantly and substantially reduced among Egyptian BP1 patients. The reproductive indices are similar among BP1 and SZ patients, suggesting a role for general illness related variables. Regardless of the cause/s, the impairment constitutes important, under-investigated disability. PMID:21994508

  8. [The application of electrical stimulation by bipolar pulsed currents and galanthamine electrophoresis for the rehabilitation of patients with diabetes mellitus].

    PubMed

    Lazarenko, N N; Gerasimenko, M Iu; Khamidullin, G N

    2011-01-01

    Clinical observations provided evidence of the positive effects of multichannel electrical stimulation by bipolar pulsed currents in combination with galanthamine electrophoresis applied for the treatment of patients with complicated diabetes mellitus. Such treatment facilitated normalization of water and carbohydrate metabolism and reduction of the body weight; moreover, it improved blood circulation and the state of the nervous system. PMID:22403949

  9. Family Functioning and Mood Disorders: A Comparison between Patients with Major Depressive Disorder and Bipolar I Disorder

    ERIC Educational Resources Information Center

    Weinstock, Lauren M.; Keitner, Gabor I.; Ryan, Christine E.; Solomon, David A.; Miller, Ivan W.

    2006-01-01

    Within a sample of patients with major depressive disorder (MDD; n = 121) and bipolar affective disorder (BPAD; n = 69), the authors examined (a) diagnostic differences in family functioning at acute episode, (b) diagnostic differences in family functioning at episode recovery, (c) within-group changes in family functioning from acute episode to…

  10. Depression and Bipolar Support Alliance

    MedlinePlus

    ... events Visit the podcast archive Mood Disorders Depression Bipolar Disorder Anxiety Screening Center Co-occurring Illnesses/Disorders Related ... for Your Patients Information about Depression Information about Bipolar Disorder Wellness Tools DBSA Support Groups Active Research Studies ...

  11. Modeling bipolar disorder in mice by increasing acetylcholine or dopamine: Chronic lithium treats most, but not all features

    PubMed Central

    van Enkhuizen, Jordy; Milienne-Petiot, Morgane; Geyer, Mark A.; Young, Jared W.

    2015-01-01

    Rationale Bipolar disorder (BD) is a disabling and life-threatening disease characterized by states of depression and mania. New and efficacious treatments have not been forthcoming partly due to a lack of well-validated models representing both facets of BD. Objectives We hypothesized that cholinergic- and dopaminergic-pharmacological manipulations would model depression and mania respectively, each attenuated by lithium treatment. Methods C57BL/6J mice received the acetylcholinesterase inhibitor physostigmine or saline before testing for ‘behavioral despair’ (immobility) in the tail-suspension test (TST) and forced-swim test (FST). Physostigmine effects on exploration and sensorimotor gating were assessed using the cross-species behavioral pattern monitor (BPM) and prepulse inhibition (PPI) paradigms. Other C57BL/6J mice received chronic lithium drinking water (300, 600, or 1200 mg/l) before assessing their effects alone in the BPM or with physostigmine on FST performance. Another group was tested with acute GBR12909 (dopamine transporter inhibitor) and chronic lithium (1000 mg/l) in the BPM. Results Physostigmine (0.03 mg/kg) increased immobility in the TST and FST without affecting activity, exploration, or PPI. Lithium (600 mg/l) resulted in low therapeutic serum concentrations and normalized the physostigmine-increased immobility in the FST. GBR12909 induced mania-like behavior in the BPM of which hyper-exploration was attenuated, though not reversed, after chronic lithium (1000 mg/ml). Conclusions Increased cholinergic levels induced depression-like behavior and hyperdopaminergia induced mania-like behavior in mice, while chronic lithium treated some, but not all, facets of these effects. These data support a cholinergic-monoaminergic mechanism for modeling BD aspects and provide a way to assess novel therapeutics. PMID:26141192

  12. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2009.

    PubMed

    Yatham, Lakshmi N; Kennedy, Sidney H; Schaffer, Ayal; Parikh, Sagar V; Beaulieu, Serge; O'Donovan, Claire; MacQueen, Glenda; McIntyre, Roger S; Sharma, Verinder; Ravindran, Arun; Young, L Trevor; Young, Allan H; Alda, Martin; Milev, Roumen; Vieta, Eduard; Calabrese, Joseph R; Berk, Michael; Ha, Kyooseob; Kapczinski, Flávio

    2009-05-01

    The Canadian Network for Mood and Anxiety Treatments (CANMAT) published guidelines for the management of bipolar disorder in 2005, with a 2007 update. This second update, in conjunction with the International Society for Bipolar Disorders (ISBD), reviews new evidence and is designed to be used in conjunction with the previous publications. The recommendations for the management of acute mania remain mostly unchanged. Lithium, valproate, and several atypical antipsychotics continue to be first-line treatments for acute mania. Tamoxifen is now suggested as a third-line augmentation option. The combination of olanzapine and carbamazepine is not recommended. For the management of bipolar depression, lithium, lamotrigine, and quetiapine monotherapy, olanzapine plus selective serotonin reuptake inhibitor (SSRI), and lithium or divalproex plus SSRI/bupropion remain first-line options. New data support the use of adjunctive modafinil as a second-line option, but also indicate that aripiprazole should not be used as monotherapy for bipolar depression. Lithium, lamotrigine, valproate, and olanzapine continue to be first-line options for maintenance treatment of bipolar disorder. New data support the use of quetiapine monotherapy and adjunctive therapy for the prevention of manic and depressive events, aripiprazole monotherapy for the prevention of manic events, and risperidone long-acting injection monotherapy and adjunctive therapy, and adjunctive ziprasidone for the prevention of mood events. Bipolar II disorder is frequently overlooked in treatment guidelines, but has an important clinical impact on patients' lives. This update provides an expanded look at bipolar II disorder. PMID:19419382

  13. Bipolar disorder

    MedlinePlus

    Manic depression; Bipolar affective disorder; Mood disorder - bipolar; Manic depressive disorder ... Bipolar disorder affects men and women equally. It most often starts between ages 15 and 25. The exact ...

  14. Review of Evidence for Use of Antidepressants in Bipolar Depression

    PubMed Central

    McInerney, Shane J.

    2014-01-01

    Objective: Depressive episodes predominate over the course of bipolar disorder and cause considerable functional impairment. Antidepressants are frequently prescribed in the treatment of bipolar depression, despite concerns about efficacy and risk of switching to mania. This review provides a critical examination of the evidence for and against the use of antidepressants in bipolar depression. Data Sources: English-language peer-reviewed literature and evidence-based guidelines published between January 1, 1980, and March 2014, were identified using PubMed, MEDLINE, PsycINFO/PsycLIT, and EMBASE. All searches contained the terms antidepressants, bipolar depression, depressive episodes in bipolar disorder, and treatment guidelines for bipolar depression. Meta-analyses, randomized controlled trials, systematic reviews, and practice guidelines were included. Bibliographies from these publications were used to identify additional articles of interest. Data Extraction: Studies involving treatment of bipolar depression with antidepressant monotherapy, adjunctive use of antidepressant with a mood stabilizer, and meta-analysis of such studies combined were reviewed. Conclusions: The body of evidence on the use of antidepressant monotherapy to treat patients with bipolar depression is contentious, but the recommendations from evidence-based guidelines do not support antidepressant monotherapy for bipolar depression. Only when mood stabilizer or atypical antipsychotic monotherapy has failed should adjunctive treatment with an antidepressant be considered. PMID:25667812

  15. Reduced prefrontal activation during performance of the Iowa Gambling Task in patients with bipolar disorder.

    PubMed

    Ono, Yasuki; Kikuchi, Mitsuru; Hirosawa, Tetsu; Hino, Shoryoku; Nagasawa, Tatsuya; Hashimoto, Takanori; Munesue, Toshio; Minabe, Yoshio

    2015-07-30

    The Iowa Gambling Task (IGT) is a complex decision-making task in which monetary wins and losses guide the development of strategies. The objective of this study was to evaluate hemodynamic responses of patients with bipolar disorder (BD) during performance of the IGT using near-infrared spectroscopy (NIRS). Participants comprised 13 patients and 15 healthy control subjects who were matched for age, sex, handedness, and intelligence quotient. Relative changes in oxygenated and deoxygenated hemoglobin (oxy-Hb and deoxy-Hb) levels in the frontal region were measured using a 46-channel NIRS system. All subjects were evaluated using NIRS during a verbal fluency task (VFT) and the IGT. During performance of the IGT, BD patients showed significantly decreased oxy-Hb levels in the bilateral orbitofrontal cortex (OFC) and left prefrontal cortex (PFC) compared with normal control subjects. However, during the VFT, patients with BD showed no significant changes in oxy-Hb levels compared with control subjects. Changes in oxy-Hb levels in the bilateral OFC and the PFC during the IGT were negatively correlated with total scores on the Hamilton Rating Scale for Depression (HAM-D). Although the IGT was useful for differentiating patients with BP from control subjects, no significant differences in autonomic activity were observed. PMID:25978934

  16. Bipolar disorder

    MedlinePlus

    Manic depression; Bipolar affective disorder; Mood disorder - bipolar; Manic depressive disorder ... happiness and high activity or energy (mania) or depression and low activity or energy (depression). The following ...

  17. Bipolar Affective Disorder and Migraine

    PubMed Central

    Engmann, Birk

    2012-01-01

    This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet. PMID:22649454

  18. Carbamazepine in Bipolar Disorder With Pain: Reviewing Treatment Guidelines

    PubMed Central

    Campbell, Austin; O’Connell, Christopher R.; Nallapula, Kishan

    2014-01-01

    Objective: To determine if any monotherapy drug treatment has robust efficacy to treat comorbid bipolar disorder and chronic pain. Data Sources: The American Psychiatric Association (APA) treatment guidelines for bipolar mood disorder and the 2012 Cochrane database for pain disorders. Study Selection: We relied on the treatment guides to determine if the drugs that are APA guideline–supported to treat bipolar disorder have supporting data from the Cochrane database for chronic pain. Data Synthesis: No single drug was mentioned by either guideline to treat this comorbidity. However, carbamazepine was the only drug that has guideline-supported robust efficacy in the management of each condition separately. Conclusions: Carbamazepine was found to have strong preclinical data for the treatment of comorbid bipolar mood disorder and chronic pain disorders. While requiring more studies in this population, we propose that this treatment modality may benefit patients. PMID:25667814

  19. Executive dysfunction and cognitive subgroups in a large sample of euthymic patients with bipolar disorder.

    PubMed

    Bora, Emre; Hıdıroğlu, Ceren; Özerdem, Ayşegül; Kaçar, Ömer Faruk; Sarısoy, Gökhan; Civil Arslan, Filiz; Aydemir, Ömer; Cubukcuoglu Tas, Zeynep; Vahip, Simavi; Atalay, Adnan; Atasoy, Nuray; Ateşci, Figen; Tümkaya, Selim

    2016-08-01

    Bipolar disorder (BP), at the group level, is associated with significant but modest cognitive deficits, including executive dysfunction. Among executive functions, response inhibition deficits have been suggested to be particularly relevant to BP. However, BP is associated with significant heterogeneity in neurocognitive performance and level of functioning. Very few studies have investigated neurocognitive subgroups in BP with data-driven methods rather than arbitrarily defined criteria. Other than having relatively small sample sizes, previous studies have not taken into consideration the neurocognitive variability in healthy subjects. Five-hundred-fifty-six euthymic patients with BP and 416 healthy controls were assessed using a battery of cognitive tests and clinical measures. Neurocognitive subgroups were investigated using latent class analysis, based on executive functions. Four neurocognitive subgroups, including a good performance cluster, two moderately low-performance groups, which differ in response inhibition and reasoning abilities, and a severe impairment cluster were found. In comparison to healthy controls, BP patients were overrepresented in severe impairment cluster (27% vs 5.3%) and underrepresented in good performance cluster. BP patients with lower educational attainment and older age were significantly more likely to be members of cognitively impaired subgroups. Antipsychotic use was less common in good performance cluster. These results suggest that there is a considerable overlap of cognitive functions between BP and healthy controls. Neurocognitive differences between BP and healthy controls are driven by a subgroup of patients who have severe and global, rather than selective, cognitive deficits. PMID:27139077

  20. Neurological and cerebellar soft signs do not discriminate schizophrenia from bipolar disorder patients.

    PubMed

    Chrobak, Adrian Andrzej; Siwek, Grzegorz Przemysław; Siuda-Krzywicka, Katarzyna; Arciszewska, Aleksandra; Starowicz-Filip, Anna; Siwek, Marcin; Dudek, Dominika

    2016-01-01

    Patients with schizophrenia (SZ) and bipolar disorder (BD) share subtle motor abnormalities called the neurological soft signs (NSS). Since in both diseases there is evidence for alterations in cerebellar functions, structure and connectivity, we expected that the cerebellar soft signs (CSS), analogue of NSS focusing strictly on cerebellar symptoms, would be also a common trait in SZ and BD. We examined 30 patients with BD, 30 patients with SZ and 28 control subjects using the Neurological Evaluation Scale (NES, for NSS) and International Cooperative Ataxia Rating Scale (ICARS, for CSS). SZ and BD did not differ in total and subscales' scores in both NES and ICARS. Subscale analysis revealed that SZ performed significantly worse than controls in all the subscales of both NES and ICARS. BD patients scored significantly worse than controls in all NES subscales and in oculomotor and kinetic subscales of the ICARS, while other ICARS subscales did not differentiate those two groups. To our knowledge this is the first study to show that CSS constitute common symptoms in BD and SZ. We recommend a special focus on those diseases in further research regarding structural and functional changes of cerebellum and their clinical outcome. PMID:26241859

  1. Diffusion Tensor Imaging in First Degree Relatives of Schizophrenia and Bipolar Disorder Patients

    PubMed Central

    Arat, Hidayet E.; Chouinard, Virginie-Anne; Cohen, Bruce M.; Lewandowski, Kathryn E.; Öngür, Dost

    2014-01-01

    Objectives White matter (WM) abnormalities are one of the most widely and consistently reported findings in schizophrenia (SZ) and bipolar disorder (BD). If these abnormalities are inherited determinants of illness, suitable to be classified as an endophenotype, relatives of patients must also have them at higher rate compared to the general population. In this review, we evaluate published diffusion tensor imaging (DTI) studies comparing first degree relatives of SZ and BD patients and healthy control subjects. Methods We searched PubMed, Embase and PsychInfo for DTI studies which included an unaffected relative and a healthy comparison group. Results 22 studies fulfilled the inclusion criteria. WM abnormalities were found in many diverse regions in relatives of SZ patients. Although the findings were not completely consistent across studies, the most implicated areas were frontal and temporal WM regions and the corpus callosum. Studies in relatives of BD patients were fewer in number with less consistent findings reported across studies. Conclusions Our review supports the concept of WM abnormalities as an endophenotype in SZ, with somewhat weaker evidence in BD, but larger and higher quality studies are needed to make a definitive comment. PMID:25542860

  2. Parallel fluctuations of psychiatric and neurological symptoms in a patient with multiple sclerosis and bipolar affective disorder.

    PubMed

    Salmaggi, A; Eoli, M; La Mantia, L; Erbetta, A

    1995-11-01

    The case of a female patient affected by simultaneously onsetting multiple sclerosis and bipolar affective disorder at age 33 is reported. Over the following years, the patient displayed minor mood fluctuations but, at the ages of 41 and 42 years, respectively, she suffered from a major depressive and a manic episode, both of which were concomitant with a marked worsening in her neurological condition. PMID:8613416

  3. Binding of lithium and boron to human plasma proteins II: results for a bipolar patient not on lithium therapy.

    PubMed

    Clarke, W Brian; Guscott, Richard; Lindstrom, Richard M

    2004-02-01

    We report further measurements of lithium and boron bound to human plasma proteins using the techniques of gel chromatography, thermal-neutron activation, and high-sensitivity helium isotope mass spectrometry. The plasma sample was donated by a bipolar patient who had never been on lithium therapy. The plasma lithium-binding pattern for the bipolar patient is distinctly different from that previously observed in this laboratory for plasma donated by a normal individual. In the bipolar case, virtually all of the lithium is bound to low-molecular-weight proteins (approx 1000 amu), whereas in the normal case, most of the lithium eluted from the gel column was bound to five high-molecular-weight proteins (approx 50,000 amu to approx 1,000,000 amu). The gel elution profiles for boron were roughly similar for the normal and bipolar cases. The lithium results are in agreement with our previous speculation that lithium-binding plasma proteins are missing or exist in very low concentrations in some individuals suffering from affective disorders. PMID:14985622

  4. Cognitive performance and cerebrospinal fluid biomarkers of neurodegeneration: a study of patients with bipolar disorder and healthy controls.

    PubMed

    Rolstad, Sindre; Jakobsson, Joel; Sellgren, Carl; Ekman, Carl-Johan; Blennow, Kaj; Zetterberg, Henrik; Pålsson, Erik; Landén, Mikael

    2015-01-01

    The purpose of the present study was to investigate if cerebrospinal fluid (CSF) biomarkers of neurodegeneration are associated with cognition in bipolar disorder and healthy controls, respectively. CSF concentrations of total and phosphorylated tau, amyloid beta (Aβ)1-42, ratios of Aβ42/40 and Aβ42/38, soluble amyloid precursor protein α and β, and neurofilament light chain protein were analyzed in relation to neuropsychological performance in 82 euthymic bipolar disorder patients and 71 healthy controls. Linear regression models were applied to account for performance in five cognitive domains using the CSF biomarkers. In patients, the CSF biomarkers explained a significant proportion of the variance (15-36%, p=.002 - <.0005) in all cognitive domains independently of age, medication, disease status, and bipolar subtype I or II. However, the CSF biomarkers specifically mirroring Alzheimer-type brain changes, i.e., P-tau and Aβ1-42, did not contribute significantly. In healthy controls, CSF biomarkers did not explain the variance in cognitive performance. Selected CSF biomarkers of neurodegenerative processes accounted for cognitive performance in persons with bipolar disorder, but not for healthy controls. Specifically, the ratios of Aβ42/40 and Aβ42/38 were consistently associated with altered cognitive performance. PMID:25954806

  5. Abnormalities in Mitochondrial Structure in Cells from Patients with Bipolar Disorder

    PubMed Central

    Cataldo, Anne M.; McPhie, Donna L.; Lange, Nicholas T.; Punzell, Steven; Elmiligy, Sarah; Ye, Nancy Z.; Froimowitz, Michael P.; Hassinger, Linda C.; Menesale, Emily B.; Sargent, Laura W.; Logan, David J.; Carpenter, Anne E.; Cohen, Bruce M.

    2010-01-01

    Postmortem, genetic, brain imaging, and peripheral cell studies all support decreased mitochondrial activity as a factor in the manifestation of Bipolar Disorder (BD). Because abnormal mitochondrial morphology is often linked to altered energy metabolism, we investigated whether changes in mitochondrial structure were present in brain and peripheral cells of patients with BD. Mitochondria from patients with BD exhibited size and distributional abnormalities compared with psychiatrically-healthy age-matched controls. Specifically, in brain, individual mitochondria profiles had significantly smaller areas, on average, in BD samples (P = 0.03). In peripheral cells, mitochondria in BD samples were concentrated proportionately more within the perinuclear region than in distal processes (P = 0.0008). These mitochondrial changes did not appear to be correlated with exposure to lithium. Also, these abnormalities in brain and peripheral cells were independent of substantial changes in the actin or tubulin cytoskeleton with which mitochondria interact. The observed changes in mitochondrial size and distribution may be linked to energy deficits and, therefore, may have consequences for cell plasticity, resilience, and survival in patients with BD, especially in brain, which has a high-energy requirement. The findings may have implications for diagnosis, if they are specific to BD, and for treatment, if they provide clues as to the underlying pathophysiology of BD. PMID:20566748

  6. Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients

    PubMed Central

    AMERIO, Andrea; TONNA, Matteo; ODONE, Anna; STUBBS, Brendon; GHAEMI, S. Nassir

    2015-01-01

    Summary Partly due to the overlap of symptom groupings in DSM, psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). However, the key nosological question about this condition – whether they are two distinct disorders or a subtype of one of the disorders – remains unresolved. In order to help address this unanswered question, we updated our recent systematic review, searching the electronic databases MEDLINE, Embase, and PsycINFO to specifically investigate the heredity in BD-OCD patients. We identified a total of 8 relevant papers, the majority of which found that, compared to non-BD-OCD patients, BD-OCD patients were more likely to have a family history for mood disorders and less likely to have a family history for OCD. These results support the view that the majority of cases of comorbid BD-OCD are, in fact, BD cases. If confirmed in larger, more focused studies, this conclusion would have important nosological and clinical implications. PMID:26977128

  7. Systematic screening for mutations in the human serotonin 1F receptor gene in patients with bipolar affective disorder and schizophrenia

    SciTech Connect

    Shimron-Abarbanell, D.; Harms, H.; Erdmann, J.; Propping, P.; Noethen, M.M.

    1996-04-09

    Using single strand conformational analysis we screened the complete coding sequence of the serotonin 1F (5-HT{sub 1F}) receptor gene for the presence of DNA sequence variation in a sample of 137 unrelated individuals including 45 schizophrenic patients, 46 bipolar patients, as well as 46 healthy controls. We detected only three rare sequence variants which are characterized by single base pair substitutions, namely a silent T{r_arrow}A transversion in the third position of codon 261 (encoding isoleucine), a silent C{r_arrow}T transition in the third position of codon 176 (encoding histidine), and a C{r_arrow}T transition in position -78 upstream from the start codon. The lack of significant mutations in patients suffering from schizophrenia and bipolar affective disorder indicates that the 5-HT{sub 1F} receptor is not commonly involved in the etiology of these diseases. 12 refs., 1 fig., 2 tabs.

  8. Efficacy and safety of olanzapine for treatment of patients with bipolar depression: Chinese subpopulation analysis of a double-blind, randomized, placebo-controlled study

    PubMed Central

    Wang, Gang; Cheng, Yan; Wang, Jia Ning; Wu, Sheng Hu; Xue, Hai Bo

    2016-01-01

    Background Depression in bipolar I disorder responds to the atypical antipsychotic olanzapine. This subpopulation analysis assessed whether olanzapine is superior to placebo specifically in the treatment of Chinese patients with bipolar I depression. Methods This was a subpopulation analysis of a 6-week, multicenter, double-blind, parallel, randomized, placebo-controlled trial among 12 Chinese study centers. Eligible inpatients and outpatients were randomized to olanzapine (5 to 20 mg/day) or placebo. Patients were primarily assessed by the Montgomery-Åsberg Depression Rating Scale total score. Secondary assessments used a range of other efficacy and safety measures. This subpopulation analysis was underpowered to show statistically significant differences between treatment groups. Results In total, 210 patients (mean age 32.9 years at baseline, 54.3% females) were random-ized. Similar proportions of patients treated with olanzapine (75.0%) and placebo (72.9%) completed the double-blind phase. Baseline-to-endpoint least-squares mean ± standard error decrease in the Montgomery-Åsberg Depression Rating Scale total score in the olanzapine group (−13.55±0.80) was similar to that noted in the parent trial (−13.82±0.65). However, the difference between olanzapine and placebo groups was not statistically significant (P=0.44); this finding was also true for the secondary efficacy measures. A post hoc analysis showed a greater emergence of mania in the placebo group, which likely reduced the treatment difference between olanzapine and placebo in the primary efficacy measure. Safety data were consistent with the known safety profile of olanzapine, including a higher incidence of weight gain (≥7%) in the olanzapine group (24.1% vs 1.4%, P<0.001). Conclusion Olanzapine provides similar improvement in depression among Chinese and non-Chinese bipolar I patients. The lack of a statistically significant difference between the olanzapine and placebo groups in this

  9. The Relationship between Impulsivity and Quality of Life in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Kim, Yoon-Seok; Lee, Dongyun; Kim, Sun-Mi; Moon, Eunsoo; Park, Chul-Soo; Kim, Bong-Jo; Lee, Cheol-Soon; Lee, Sojin

    2013-01-01

    Objective Bipolar disorder (BD) is characterized by elevated impulsivity, even during periods of remission. Many recovered BD patients have functional impairments, which can lead to poor quality of life (QoL). The aim of this study was to investigate the association between impulsivity and QoL in euthymic BD patients. Methods A total of 56 remitted or recovered patients with type I or II BD, diagnosed based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria, were recruited. Psychiatrists administered the Clinical Global Impression (CGI) for BD and the Global Assessment of Functioning (GAF) scales and then interviewed the subjects to assess clinical variables. Patients completed the Barratt Impulsiveness Scale (BIS-11) and the World Health Organization Quality of Life Assessment Instrument-Brief Form (WHOQoL-BREF). Pearson correlations, univariate regression analyses, and multiple linear regression analyses were performed. Results The BIS-11 total score was significantly correlated with the WHOQoL-BREF total score (r=-0.55, p<0.01) and with the WHOQoL-BREF subscales. After controlling for GAF score and other clinical variables, the BIS-11 total score (β=-0.43, p=0.001) was independently associated with overall QoL. Additionally, the BIS-11 total score was particularly strongly associated with the physical, psychological, and social domains of the multi-dimensional QoL scale. Conclusion Our results suggest that high impulsivity is related to low QoL in euthymic BD patients. Further studies are needed to examine whether interventions for high impulsivity effectively improve QoL in patients with BD. PMID:24302947

  10. Behavioral Treatment of Insomnia in Bipolar Disorder

    PubMed Central

    Kaplan, Katherine A.; Harvey, Allison G.

    2014-01-01

    Sleep disturbance is common in bipolar disorder. Stimulus control and sleep restriction are powerful, clinically useful behavioral interventions for insomnia, typically delivered as part of cognitive-behavioral therapy for insomnia (CBT-I). Both involve short-term sleep deprivation. The potential for manic or hypomanic symptoms to emerge after sleep deprivation in bipolar disorder raises questions about the appropriateness of these methods for treating insomnia. In a series of patients with bipolar disorder who underwent behavioral treatment for insomnia, the authors found that regularizing bedtimes and rise times was often sufficient to bring about improvements in sleep. Two patients in a total group of 15 patients reported mild increases in hypomanic symptoms the week following instruction on stimulus control. Total sleep time did not change for these individuals. Two of five patients who underwent sleep restriction reported mild hypomania that was unrelated to weekly sleep duration. Sleep restriction and stimulus control appear to be safe and efficacious procedures for treating insomnia in patients with bipolar disorder. Practitioners should encourage regularity in bedtimes and rise times as a first step in treatment, and carefully monitor changes in mood and daytime sleepiness throughout the intervention. PMID:23820830

  11. A limit cycle oscillator model for cycling mood variations of bipolar disorder patients derived from cellular biochemical reaction equations

    NASA Astrophysics Data System (ADS)

    Frank, T. D.

    2013-08-01

    We derive a nonlinear limit cycle model for oscillatory mood variations as observed in patients with cycling bipolar disorder. To this end, we consider two signaling pathways leading to the activation of two enzymes that play a key role for cellular and neural processes. We model pathway cross-talk in terms of an inhibitory impact of the first pathway on the second and an excitatory impact of the second on the first. The model also involves a negative feedback loop (inhibitory self-regulation) for the first pathway and a positive feedback loop (excitatory self-regulation) for the second pathway. We demonstrate that due to the cross-talk the biochemical dynamics is described by an oscillator equation. Under disease-free conditions the oscillatory system exhibits a stable fixed point. The breakdown of the self-inhibition of the first pathway at higher concentration levels is studied by means of a scalar control parameter ξ, where ξ equal to zero refers to intact self-inhibition at all concentration levels. Under certain conditions, stable limit cycle solutions emerge at critical parameter values of ξ larger than zero. These oscillations mimic pathological cycling mood variations that emerge due to a disease-induced bifurcation. Consequently, our modeling analysis supports the notion of bipolar disorder as a dynamical disease. In addition, our study establishes a connection between mechanistic biochemical modeling of bipolar disorder and phenomenological nonlinear oscillator approaches to bipolar disorder suggested in the literature.

  12. [Antipsychotics in bipolar disorders].

    PubMed

    Vacheron-Trystram, M-N; Braitman, A; Cheref, S; Auffray, L

    2004-01-01

    This article is a review of the various treatments that are currently available, in particular in France, for the treatment of bipolar disorders. This article specifically addresses the use of novel antipsychotic agents as alternative therapy to a lithium therapy and/or the use of conventional antipsychotics. The prevalence of bipolar disorder over a lifetime is around 1% of the general population. Bipolar disorder consists of alternating depressive and manic episodes. It mainly affects younger subjects, and is often associated with alcohol and drug addictions. There are two main subtypes of bipolar disorder. According to the DSM IV-R, type 1 of bipolar disorder is characterised when at least one manic episode (or a mixed episode) has been diagnosed. Type 2 of bipolar disorder is related to patients enduring recurrent depressive episodes but no manic episode. Type 2 affects women more frequently as opposed to type 1 affecting individuals of both sexes. Manic-depressive disorder (or cyclo-thymic disorder) appears in relation to patients who has never suffered manic episode, mixed episode or severe depressive episode but have undergone numerous periods with some symptoms of depression and hypomanic symptoms over a two-year period during which any asymptomatic periods last no longer than two months. The average age of the person going through a first episode (often a depressive one) is 20 years-old. Untreated bipolar patients may endure more than ten manic or depressive episodes. Finally, in relation to 10 to 20% of patients, the bipolar disorder will turn into a fast cycle form, either spontaneously or as a result of certain medical treatments. Psychiatrists are now able to initiate various treating strategies which are most likely to be effective as a result of the identification of clinical subtypes of the bipolar disorder. Lithium therapy has been effectively and acutely used for patients with pure or elated mania and its prophylaxis. However, lithium medication

  13. Differential Expression of Exosomal microRNAs in Prefrontal Cortices of Schizophrenia and Bipolar Disorder Patients

    PubMed Central

    Kozubek, James A.; Winslow, Ashley R.; Medina, Juan; Costa, Joan; Schmitt, Andrea; Schneider, Anja; Cabral, Howard; Cagsal-Getkin, Ozge; Vanderburg, Charles R.; Delalle, Ivana

    2013-01-01

    Exosomes are cellular secretory vesicles containing microRNAs (miRNAs). Once secreted, exosomes are able to attach to recipient cells and release miRNAs potentially modulating the function of the recipient cell. We hypothesized that exosomal miRNA expression in brains of patients diagnosed with schizophrenia (SZ) and bipolar disorder (BD) might differ from controls, reflecting either disease-specific or common aberrations in SZ and BD patients. The sources of the analyzed samples included McLean 66 Cohort Collection (Harvard Brain Tissue Resource Center), BrainNet Europe II (BNE, a consortium of 18 brain banks across Europe) and Boston Medical Center (BMC). Exosomal miRNAs from frozen postmortem prefrontal cortices with well-preserved RNA were isolated and submitted to profiling by Luminex FLEXMAP 3D microfluidic device. Multiple statistical analyses of microarray data suggested that certain exosomal miRNAs were differentially expressed in SZ and BD subjects in comparison to controls. RT-PCR validation confirmed that two miRNAs, miR-497 in SZ samples and miR-29c in BD samples, have significantly increased expression when compared to control samples. These results warrant future studies to evaluate the potential of exosome-derived miRNAs to serve as biomarkers of SZ and BD. PMID:23382797

  14. Coping strategies used by poorly adherent patients for self-managing bipolar disorder

    PubMed Central

    Blixen, Carol; Levin, Jennifer B; Cassidy, Kristin A; Perzynski, Adam T; Sajatovic, Martha

    2016-01-01

    Background Bipolar disorder (BD) is a chronic mental illness associated with reduced quality of life, high rates of suicide, and high financial costs. Evidence indicates that psychosocial stress might play an important role in the onset and course of BD. Objective The objective of this study was to address the gap between coping theory and the clinical use of coping strategies used to self-manage BD. Methods In-depth interviews were conducted with a sample of 21 poorly adherent patients with BD. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. Results Transcript-based analysis generated two major domains of coping strategies used to self-manage BD: 1) problem focused (altering eating habits, managing mood-stabilizing medications, keeping psychiatric appointments, seeking knowledge, self-monitoring, and socializing) and 2) emotion focused (distracting activities, denial, isolation, modifying/avoiding, helping others, and seeking social support). Participants used both types of coping strategies to deal with stressful situations brought about by the internal and external demands associated with self-management of BD. Conclusion This qualitative study provided a first step in evaluating coping strategies as a possible mediator in the self-management of BD and has implications for health care providers. Being able to characterize an individual’s coping behaviors can help patients modify or replace more maladaptive coping with better coping strategies in the self-management of this chronic mental illness. PMID:27524888

  15. Altered Cortico-Striatal Connectivity in Offspring of Schizophrenia Patients Relative to Offspring of Bipolar Patients and Controls.

    PubMed

    Solé-Padullés, Cristina; Castro-Fornieles, Josefina; de la Serna, Elena; Romero, Soledad; Calvo, Anna; Sánchez-Gistau, Vanessa; Padrós-Fornieles, Marta; Baeza, Inmaculada; Bargalló, Núria; Frangou, Sophia; Sugranyes, Gisela

    2016-01-01

    Schizophrenia (SZ) and bipolar disorder (BD) share clinical features, genetic risk factors and neuroimaging abnormalities. There is evidence of disrupted connectivity in resting state networks in patients with SZ and BD and their unaffected relatives. Resting state networks are known to undergo reorganization during youth coinciding with the period of increased incidence for both disorders. We therefore focused on characterizing resting state network connectivity in youth at familial risk for SZ or BD to identify alterations arising during this period. We measured resting-state functional connectivity in a sample of 106 youth, aged 7-19 years, comprising offspring of patients with SZ (N = 27), offspring of patients with BD (N = 39) and offspring of community control parents (N = 40). We used Independent Component Analysis to assess functional connectivity within the default mode, executive control, salience and basal ganglia networks and define their relationship to grey matter volume, clinical and cognitive measures. There was no difference in connectivity within any of the networks examined between offspring of patients with BD and offspring of community controls. In contrast, offspring of patients with SZ showed reduced connectivity within the left basal ganglia network compared to control offspring, and they showed a positive correlation between connectivity in this network and grey matter volume in the left caudate. Our findings suggest that dysconnectivity in the basal ganglia network is a robust correlate of familial risk for SZ and can be detected during childhood and adolescence. PMID:26885824

  16. Altered Cortico-Striatal Connectivity in Offspring of Schizophrenia Patients Relative to Offspring of Bipolar Patients and Controls

    PubMed Central

    Solé-Padullés, Cristina; Castro-Fornieles, Josefina; de la Serna, Elena; Romero, Soledad; Calvo, Anna; Sánchez-Gistau, Vanessa; Padrós-Fornieles, Marta; Baeza, Inmaculada; Bargalló, Núria; Frangou, Sophia; Sugranyes, Gisela

    2016-01-01

    Schizophrenia (SZ) and bipolar disorder (BD) share clinical features, genetic risk factors and neuroimaging abnormalities. There is evidence of disrupted connectivity in resting state networks in patients with SZ and BD and their unaffected relatives. Resting state networks are known to undergo reorganization during youth coinciding with the period of increased incidence for both disorders. We therefore focused on characterizing resting state network connectivity in youth at familial risk for SZ or BD to identify alterations arising during this period. We measured resting-state functional connectivity in a sample of 106 youth, aged 7–19 years, comprising offspring of patients with SZ (N = 27), offspring of patients with BD (N = 39) and offspring of community control parents (N = 40). We used Independent Component Analysis to assess functional connectivity within the default mode, executive control, salience and basal ganglia networks and define their relationship to grey matter volume, clinical and cognitive measures. There was no difference in connectivity within any of the networks examined between offspring of patients with BD and offspring of community controls. In contrast, offspring of patients with SZ showed reduced connectivity within the left basal ganglia network compared to control offspring, and they showed a positive correlation between connectivity in this network and grey matter volume in the left caudate. Our findings suggest that dysconnectivity in the basal ganglia network is a robust correlate of familial risk for SZ and can be detected during childhood and adolescence. PMID:26885824

  17. Valproic Acid Induced Hyperammonemia in a Long Time Treated Patient

    PubMed Central

    Seide, Margaret; Stern, Robert G.

    2016-01-01

    We report a case of a patient who had been on long time valproic acid for treatment of bipolar affective disorder. While being an inpatient, serology ammonia level testing revealed a very high ammonia level despite being asymptomatic. Dual therapy of carnitine and lactulose was provided to the patient for treatment of the hyperammonemia. It should also be noted that, during this treatment, valproic acid was not stopped. Consequently, this case illustrates that patients can present asymptomatically despite very high ammonia levels and hyperammonemia can occur in chronic valproic acid despite not increasing the dose of the medication and psychiatrists do not need to discontinue valproic acid in the presence of elevated levels of ammonia if the patient shows no signs of encephalopathy or delirium. PMID:27516916

  18. Valproic Acid Induced Hyperammonemia in a Long Time Treated Patient.

    PubMed

    Aiyer, Rohit; Seide, Margaret; Stern, Robert G

    2016-01-01

    We report a case of a patient who had been on long time valproic acid for treatment of bipolar affective disorder. While being an inpatient, serology ammonia level testing revealed a very high ammonia level despite being asymptomatic. Dual therapy of carnitine and lactulose was provided to the patient for treatment of the hyperammonemia. It should also be noted that, during this treatment, valproic acid was not stopped. Consequently, this case illustrates that patients can present asymptomatically despite very high ammonia levels and hyperammonemia can occur in chronic valproic acid despite not increasing the dose of the medication and psychiatrists do not need to discontinue valproic acid in the presence of elevated levels of ammonia if the patient shows no signs of encephalopathy or delirium. PMID:27516916

  19. Comparison of hemodynamic changes between old and very old patients undergoing cemented bipolar hemiarthroplasty under spinal anesthesia

    PubMed Central

    Park, Hye Jin; Lee, Jae-Woo; Baek, Seung Min; Seo, Jeong Seung

    2015-01-01

    Background The old age population, including the very old aged (≥ 85 years), is rapidly increasing, and femur neck fracture from accidents is commonly seen in the elderly. Use of bone cement during bipolar hemiarthroplasty can cause bone cement implantation syndrome. Methods This study was prospectively conducted on the elderly who were scheduled to undergo elective cemented bipolar hemiarthroplasty under spinal anesthesia. Patients were divided into 2 groups: the old age (65-84 years) and very old age groups (≥ 85 years). Hemodynamic parameters were recorded at the following time points: the start of the operation, femoral reaming, cement insertion, every 2 minutes after cement insertion for 10 minutes, femoral joint reduction, and the end of operation. When hypotension occurred, ephedrine was given. Results Sixty-five patients in the old age group and 32 patients in the very old age group were enrolled. Mean ages were 78.9 and 89.4 years, respectively, in the old age and very old age groups. The very old age group showed constantly decreased levels of cardiac index and stroke volume from cementing until the end of the operation compared to the old age group. To maintain hemodynamic stability after cement insertion, the requirement of ephedrine was higher in the very old age group than in the old age group (13.52 ± 7.76 vs 8.65 ± 6.38 mg, P = 0.001). Conclusions Bone cement implantation during bipolar hemiarthroplasty may cause more prominent hemodynamic changes in very elderly patients. Careful hemodynamic monitoring and management are warranted in very elderly patients undergoing cemented bipolar hemiarthroplasty. PMID:25664154

  20. Amygdala volume in depressed patients with bipolar disorder assessed using high resolution 3T MRI: the impact of medication.

    PubMed

    Savitz, Jonathan; Nugent, Allison C; Bogers, Wendy; Liu, Alice; Sills, Rebecca; Luckenbaugh, David A; Bain, Earle E; Price, Joseph L; Zarate, Carlos; Manji, Husseini K; Cannon, Dara M; Marrett, Sean; Charney, Dennis S; Drevets, Wayne C

    2010-02-15

    MRI-based reports of both abnormally increased and decreased amygdala volume in bipolar disorder (BD) have surfaced in the literature. Two major methodological weaknesses characterizing extant studies are treatment with medication and inaccurate segmentation of the amygdala due to limitations in spatial and tissue contrast resolution. Here, we acquired high-resolution images (voxel size=0.55 x 0.55 x 0.60 mm) using a GE 3T MRI scanner, and a pulse sequence optimized for tissue contrast resolution. The amygdala was manually segmented by one rater blind to diagnosis, using coronal images. Eighteen unmedicated (mean medication-free period 11+/-10 months) BD subjects were age and gender matched with 18 healthy controls, and 17 medicated (lithium or divalproex) subjects were matched to 17 different controls. The unmedicated BD patients displayed smaller left and right amygdala volumes than their matched control group (p<0.01). Conversely, the BD subjects undergoing medication treatment showed a trend towards greater amygdala volumes than their matched HC sample (p=0.051). Right and left amygdala volumes were larger (p<0.05) or trended larger, respectively, in the medicated BD sample compared with the unmedicated BD sample. The two control groups did not differ from each other in either left or right amygdala volume. BD patients treated with lithium have displayed increased gray matter volume of the cortex and hippocampus relative to untreated BD subjects in previous studies. Here we extend these results to the amygdala. We raise the possibility that neuroplastic changes in the amygdala associated with BD are moderated by some mood stabilizing medications. PMID:19931399

  1. Comparative Study of Personality Traits in Patients with Bipolar I and II Disorder from the Five-Factor Model Perspective

    PubMed Central

    Kim, Byungsu; Lim, Jong-Han; Kim, Seong Yoon

    2012-01-01

    Objective The distinguishing features of Bipolar I Disorder (BD I) from Bipolar II Disorder (BD II) may reflect a separation in enduring trait dimension between the two subtypes. We therefore assessed the similarities and differences in personality traits in patients with BD I and BD II from the perspective of the Five-Factor Model (FFM). Methods The revised NEO Personality Inventory (NEO-PI-R) was administered to 85 BD I (47 females, 38 males) and 43 BD II (23 females, 20 males) patients. All included patients were in remission from their most recent episode and in a euthymic state for at least 8 weeks prior to study entry. Results BDII patients scored higher than BD I patients on the Neuroticism dimension and its four corresponding facets (Anxiety, Depression, Self-consciousness, and Vulnerability). In contrast, BD II patients scored lower than BD I patients on the Extraversion dimension and its facet, Positive emotion. Competence and Achievement-striving facets within the Conscientiousness dimension were significantly lower for BD II than for BD I patients. There were no significant between-group differences in the Openness and Agreeableness dimensions. Conclusion Disparities in personality traits were observed between BD I and BD II patients from the FFM perspective. BD II patients had higher Neuroticism and lower Extraversion than BD I patients, which are differentiating natures between the two subtypes based on the FFM. PMID:23251198

  2. Effects of switching to aripiprazole from current atypical antipsychotics on subsyndromal symptoms and tolerability in patients with bipolar disorder.

    PubMed

    Woo, Young Sup; Bahk, Won-Myong; Park, Young-Min; Chung, Sangkeun; Yoon, Bo-Hyun; Won, Seunghee; Lee, Jeong Goo; Lee, Hwang-Bin; Kim, Won; Jeong, Jong-Hyun; Lee, Kwanghun; Kim, Moon-Doo

    2016-09-01

    We evaluated the effectiveness of aripiprazole among bipolar patients who had switched to this medication as a result of difficulty maintaining on their prestudy atypical antipsychotics (AAPs) because of subsyndromal mood symptoms or intolerance. This study included 77 bipolar patients who were in syndromal remission with an AAP as monotherapy or with an AAP combined with a mood stabilizer(s) who needed to switch from their present AAP because of subsyndromal symptoms or intolerance. At 24 weeks after switching to aripiprazole, the remission rates on the Montgomery-Åsberg Depression Rating Scale (MADRS) and on both the MADRS and the Young Mania Rating Scale were increased significantly in the full sample and in the inefficacy subgroup. In the inefficacy subgroup, the MADRS score change was significant during the 24 weeks of study. Total cholesterol and prolactin decreased significantly after switching to aripiprazole. The proportion of patients who had abnormal values for central obesity and hypercholesterolemia decreased significantly from baseline to week 24. These findings suggest that a change from the current AAP to aripiprazole was associated with improvement in subsyndromal mood symptoms and several lipid/metabolic or safety profile parameters in patients with bipolar disorder with tolerability concerns or subsyndromal mood symptoms. PMID:27487259

  3. Incidence and predictors of pacemaker dysfunction with unipolar ventricular lead configuration. Can we identify patients who benefit from bipolar electrodes?

    PubMed

    Wiegand, U K; Bode, F; Bonnemeier, H; Tölg, R; Peters, W; Katus, H A

    2001-09-01

    Unipolar ventricular leads were implanted in a considerable percentage of pacemaker recipients. There is little information on incidence and risk factors for unipolar pacemaker dysfunction using modern lead designs. Included in a cross-sectional analysis were 682 patients who fulfilled the following criteria: chronically implanted bipolar ventricular leads (> 1 year), intraoperative stimulation threshold < 1.0 V/0.5 ms, and potential amplitude > 6 mV. Incidences of chest wall stimulation (CWS) at an output of twice the amplitude threshold and of myopotential oversensing (MPO) at a sensitivity of half the sensing threshold were assessed. Energy (0.60 [0.72] vs 0.63 [0.81] microJ) and sensing thresholds (8.31 [3.18] mV vs 8.47 [3.47] mV) did not differ between uni- and bipolar modes. While all pacemakers worked properly during bipolar configuration, malfunctions were observed in 5.9% of patients during unipolar configuration (CWS = 1.9%, MPO = 4.2%). Patient age > 76 years (hazard ratio HR 8.2; P < 0.001), heart failure > or = NYHA Class II (HR 3.8; P < 0.001), and an antiarrhythmic therapy with Class I or III drugs (HR 3.3; P = 0.002) were independently associated with the occurrence of unipolar pacemaker dysfunction. Use of steroid-eluting leads reduced the probability of pacemaker dysfunction (HR 0.45; P = 0.03). Risk factors for unipolar ventricular pacemaker malfunction were higher age, heart failure, and antiarrhythmic drug therapy. Particularly in these patients, use of bipolar ventricular leads is beneficial. PMID:11584461

  4. The Relationship between Cognitive Decline and Psychopathology in Patients with Schizophrenia and Bipolar Disorder

    PubMed Central

    Kim, Moon-Doo; Seo, Hye-Jin; Yun, Hyunju; Jung, Young-Eun; Park, Joon Hyuk; Lee, Chang-In; Moon, Ji Hyun; Hong, Seong-Chul; Yoon, Bo-Hyun; Bahk, Won-Myong

    2015-01-01

    Objective The primary goals of the present study were to assess intellectual function in participants with schizophrenia or bipolar disorder (BD) and to investigate the relationships between cognitive decline and the severity of each type of psychopathology. Methods The present study included 51 patients with schizophrenia and 42 with BD who were recruited from the psychiatry outpatient clinic of Jeju University Hospital between March 2011 and March 2014. The Korean Wechsler Adult Intelligence Scale (K-WAIS) was administered to each of the 93 participants, and they were categorized into two groups based on their current intelligence quotient (IQ) and their estimated premorbid IQ: severely impaired group (SIG) and mildly impaired group (MIG). The Minnesota Multiple Personality Inventory (MMPI) and the Brief Psychiatric Rating Scale (BPRS) were used to assess psychopathology. Results The SIG schizophrenia participants exhibited significantly higher scores on the frequent (F) and schizophrenia (Sc) subscales of the MMPI, but significantly lower scores on the correction (K) and psychopathic deviate (Pd) subscales compared with the MIG schizophrenia participants. Furthermore, the BPRS scores were significantly higher in the SIG schizophrenia participants relative to the MIG schizophrenia participants. The SIG BD participants had significantly higher F, masculinity-femininity (Mf), paranoia (Pa), and Sc but significantly lower Pd scores compared with the MIG BD participants. Conclusion The present findings revealed a significant discrepancy between the estimated premorbid levels of cognitive function and current cognitive function in participants with schizophrenia or BD. Moreover, this discrepancy was correlated with severity of psychopathology in both groups. PMID:25912543

  5. Increased DNA and RNA damage by oxidation in patients with bipolar I disorder.

    PubMed

    Jacoby, A S; Vinberg, M; Poulsen, H E; Kessing, L V; Munkholm, K

    2016-01-01

    The mechanisms underlying bipolar disorder (BD) and the associated medical burden are unclear. Damage generated by oxidation of nucleosides may be implicated in BD pathophysiology; however, evidence from in vivo studies is limited and the extent of state-related alterations is unclear. This prospective study investigated for we believe the first time the damage generated by oxidation of DNA and RNA strictly in patients with type I BD in a manic or mixed state and subsequent episodes and remission compared with healthy control subjects. Urinary excretion of 8-oxo-deoxyguanosine (8-oxodG) and 8-oxo-guanosine (8-oxoGuo), valid markers of whole-body DNA and RNA damage by oxidation, respectively, was measured in 54 patients with BD I and in 35 healthy control subjects using a modified ultraperformance liquid chromatography and mass spectrometry assay. Repeated measurements were evaluated in various affective phases during a 6- to 12-month period and compared with repeated measurements in healthy control subjects. Independent of lifestyle and demographic variables, a 34% (P<0.0001) increase in RNA damage by oxidation across all affective states, including euthymia, was found in patients with BD I compared with healthy control subjects. Increases in DNA and RNA oxidation of 18% (P<0.0001) and 8% (P=0.02), respectively, were found in manic/hypomanic states compared with euthymia, and levels of 8-oxodG decreased 15% (P<0.0001) from a manic or mixed episode to remission. The results indicate a role for DNA and RNA damage by oxidation in BD pathophysiology and a potential for urinary 8-oxodG and 8-oxoGuo to function as biological markers of diagnosis, state and treatment response in BD. PMID:27505230

  6. Thalidomide in Treating Patients With Myelodysplastic Syndrome

    ClinicalTrials.gov

    2013-01-23

    Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Refractory Anemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Anemia With Ringed Sideroblasts; Secondary Myelodysplastic Syndromes

  7. Delays before Diagnosis and Initiation of Treatment in Patients Presenting to Mental Health Services with Bipolar Disorder

    PubMed Central

    Patel, Rashmi; Shetty, Hitesh; Jackson, Richard; Broadbent, Matthew; Stewart, Robert; Boydell, Jane; McGuire, Philip; Taylor, Matthew

    2015-01-01

    underlying symptoms and offer appropriate treatment sooner in order to facilitate improved clinical outcomes, such as developing specialist early intervention services to identify and treat people with bipolar disorder. PMID:25992560

  8. Mechanisms underlying the benefits of anticonvulsants over lithium in the treatment of bipolar disorder.

    PubMed

    Corrado, Alisa C; Walsh, John P

    2016-02-10

    Close to 3% of the world's population suffers from bipolar disease (I and II). Of this 3%, bipolar disease affects largely women (∼ 3 : 2 compared with men). The median age of diagnosis is 25 in women and even lower in men. A diagnosis of bipolar disease is an expensive psychiatric diagnosis, costing patients more than twice as much money as a diagnosis of unipolar depression. Bipolar I is characterized by one or more manic or mixed episodes, with both mania and depression occurring each day for at least 1 week, whereas bipolar II is characterized by one or more major depressive episode and at least one episode of hypomania. Bipolar I is the more severe diagnosis. A wide range of medications are available to help patients maintain a healthy lifestyle, including lithium, antidepressants, and anticonvulsants. Improved methods for identifying bipolar disease, including a more structured approach and a more complete use of medical records, have increased the rate of diagnosis, especially in children, which underscores the need for innovation in development and in practice of new treatment options for treating bipolar disease. Although lithium has been the 'gold standard' for treating bipolar disorder for decades, new research into other forms of treatment has shown anticonvulsants to be a particularly useful therapy for treating bipolar disease. Anticonvulsants have remarkable mood-stabilization abilities and they do not lead to serious side effects, which increases the tolerability, and consequently, patient adherence to this form of treatment. Recent studies have shown that anticonvulsants improve behavior in bipolar disease by modulating the balance of excitatory and inhibitory synapses through a number of complementary molecular cascades that affect gene expression and cell survival. PMID:26702549

  9. Insight in bipolar disorder.

    PubMed

    Látalová, Klára

    2012-09-01

    Although there has been interest in insight in bipolar disorder, research has not been as developed as in schizophrenia. The Medline, Embase, and PsychInfo data bases were searched. The key words used in the search were "bipolar", "mania", "manic", "awareness", and "insight". Books, editorials, letters, and reports on pediatric subjects were excluded. Abstracts or full texts were screened for relevance. Better insight is associated with better adherence to treatment and better outcomes. Impairments of executive functions and memory, as well as higher severity of psychotic symptoms, are associated with impairments of insight. Insight is more impaired during an illness episode than during remission, in mixed than in pure manic episodes, in bipolar II than in bipolar I patients, in pure mania than in bipolar or unipolar depression. Psychosocial treatments improve insight and outcomes. There is a need for integration of quantitative assessment methods and their introduction into research and clinical practice. PMID:22101737

  10. Mono- and combination drug therapies in hospitalized patients with bipolar depression. Data from the European drug surveillance program AMSP

    PubMed Central

    2012-01-01

    Background For the pharmacological treatment of bipolar depression several guidelines exist. It is largely unknown, to what extent the prescriptions in daily clinical routine correspond to these evidence based recommendations and which combinations of psychotropic drugs are frequently used. Methods The prescriptions of psychotropic drugs were investigated of all in-patients with bipolar depression (n = 2246; time period 1994–2009) from hospitals participating in the drug surveillance program AMSP. For the drug use in 2010, 221 cases were analysed additionally. Results From 1994 to 2009, 85% of all patients received more than one class of psychotropic substances: 74% received antidepressants in combination therapy, 55% antipsychotics, 48% anticonvulsants and 33% lithium. When given in combination, lithium is the most often prescribed substance for bipolar depression (33%), followed by valproic acid (23%), mirtazapine and venlafaxine (16% each), quetiapine (15%), lamotrigine (14%) and olanzapine (13%). Both, lithium and valproic acid are often combined with selective serotonin reuptake inhibitors (SSRI), but also with mirtazapine und venlafaxine. Combinations of more than one antidepressant occur quite often, whereby combinations with bupropion, paroxetine, fluoxetine or fluvoxamine are very rare. In 2010, quetiapine (alone and combined) was the most frequently prescribed drug (39%); aripiprazole was administered in 10%. Conclusion Combinations of antidepressants (SSRI, mirtazapine, venlafaxine) with mood stabilizers (lithium, valproic acid, lamotrigine) and / or atypical antipsychotics (quetiapine, olanzapine) are common. Of most of those combinations the efficacy has not been studied. The use of aripiprazole and the concomitant use of two or three antidepressants contrast the guidelines. PMID:22998655

  11. A clinical study comparing BIVAP saline vaporization of the prostate with bipolar TURP in patients with prostate volume 30 to 80 mL: Early complications, physiological changes and postoperative follow-up outcomes

    PubMed Central

    Aydogdu, Ozgu; Karakose, Ayhan; Atesci, Yusuf Ziya

    2014-01-01

    Introduction: We compare BIVAP saline vaporization of the prostate with bipolar transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia. Methods: In total, we included 86 patients treated with BIVAP (n = 44) and bipolar TURP (n = 42). The inclusion criteria were maximum urinary flow rate (Qmax) ≤10 mL/s, International Prostate Symptom Score (IPSS) ≥16, and prostate volume measured with transrectal ultrasound scan between 30 and 80 mL. Serum electrolyte, hemoglobin, and hematocrit levels were determined preoperatively and postoperatively. All patients were evaluated at the postoperative first and third months and the IPSS score, post-void residual urinary volume (PVR), Qmax, and average urinary flow rate (Qave) were compared. Statistical analyses were performed using SPSS 16.0 program and statistical significance was set at p < 0.05. Results: Preoperative demographic characteristics were similar in the 2 groups. The mean operation time was significantly higher (p = 0.02) and hospitalization time was significantly lower (p = 0.04) in the BIVAP group when compared to the bipolar TURP group. There was no significant difference between 2 groups in terms of preoperative and postoperative serum electrolyte, hemoglobin and hematocrit levels. Postoperative complication rates were similar in the 2 groups. The only exception was the rate of severe dysuria, which was significantly higher in the BIVAP group. No statistical difference was noted between the groups in terms of postoperative follow-up results. Conclusion: Bipolar TURP is a safe and highly effective technique which can be used in the surgical treatment of benign prostatic obstruction with minimal side effects. BIVAP saline vaporization of the prostate seems to be a potential alternative to bipolar TURP with shorter hospitalization time. PMID:25132894

  12. [Psychotherapy for bipolar disorder : a systematic review of controlled studies].

    PubMed

    Hautzinger, M; Meyer, T D

    2007-11-01

    Mood stabilisers show convincing evidence of relapse prevention in patients suffering from bipolar affective disorder. However, despite continuous medication the majority of patients suffer from relapses. It seems logical to apply principles of psychological intervention to bipolar patients. Elements of psychotherapy are: psychoeducation about symptoms, prodromal states, and course of illness; symptom monitoring; and influencing cognitive and behavioural strategies to improve symptomatology, social functioning, compliance, and relapse prevention. The goal of this review is to summarise the current status of controlled studies including psychological approaches to bipolar patients, to describe the efficacy of psychotherapy, and to address lack of knowledge and future trends in this clinical field. We located 461 reports about psychological interventions with bipolar patients but identified only 28 controlled and methodologically sound studies. In those studies 2294 patients were treated. Almost all (over 90%) fulfilled bipolar I criteria. All psychotherapies include psychoeducation and information about bipolar affective disorders and ask patients to self-monitor daily symptoms and other daily events. The majority of psychotherapies are cognitive-behaviorally oriented and treat patients in a one-to-one setting, but family oriented approaches and group settings were also prevalent. Studies show evidence that psychotherapy in combination with mood stabilizers improved depressive (to less extent manic) symptoms (d=0.39) and almost doubled the period of time between two episodes (d=0.71). Open questions are: indicators and predictors of successful outcome, length and intensity of treatment, essential elements of helpful intervention, long-term follow-up, and prevention of bipolar disorders in high-risk groups. PMID:17604972

  13. Effects of Omega-3 Supplement in the Treatment of Patients with Bipolar I Disorder

    PubMed Central

    Shakeri, Jalal; Khanegi, Maryam; Golshani, Sanobar; Farnia, Vahid; Tatari, Faeze; Alikhani, Mostafa; Nooripour, Roghih; Ghezelbash, Mohammad Saeed

    2016-01-01

    Background: Fatty acids play various physiological roles in the organism; they are crucial for the structure of cell membranes, metabolic processes, transmission of nerve impulses and brain functions. In recent years, particular attention has been paid to the rich sources of omega-3 for the treatment of many diseases, especially mental illnesses. The present study aimed to investigate the effects of omega-3 supplement in the treatment of patients with bipolar I disorder (BID). Methods: In this double-blind clinical trial, 100 patients suffering from BIDs were randomly divided into two, i.e. control (n = 50) and experimental (n = 50) groups. In addition to the other standard treatments, 1000 mg of omega-3 supplement was given to the experimental group on daily basis for 3 months and placebo was given to the control group. The Young Mania Rating Scale was completed for both groups before and after the intervention. Afterward, data were analyzed using paired t-test, independent t-test, and Chi-square test. Results: Before intervention, mean severity of mania in the experimental group (23.50 ± 7.02) and control group (23.70 ± 8.09) was not significant (P ≤ 0.89). The difference after the intervention in the experimental group (10.64 ± 3.3) and control group (20.12 ± 6.78) was significant (P < 0.01). The mean intensity of mania before (23.50 ± 7.02) and after (10.64 ± 3.3) intervention reported to be significant at P < 0.05. Conclusions: Since omega-3 supplement was effective for the treatment of BID, it is suggested to use omega-3 supplements as an adjuvant therapy along with the other pharmacotherapies. PMID:27280013

  14. Bipolar Disorder

    MedlinePlus

    Bipolar disorder is a serious mental illness. People who have it go through unusual mood changes. They go ... The down feeling is depression. The causes of bipolar disorder aren't always clear. It runs in families. ...

  15. Impaired Theory of Mind and psychosocial functioning among pediatric patients with Type I versus Type II bipolar disorder.

    PubMed

    Schenkel, Lindsay S; Chamberlain, Todd F; Towne, Terra L

    2014-03-30

    Deficits in Theory of Mind (ToM) have been documented among pediatric patients with Bipolar Disorder (BD). However, fewer studies have directly examined differences between type I and type II patients and whether or not ToM deficits are related to psychosocial difficulties. Therefore, the aim of this study was to compare type I versus type II pediatric bipolar patients and matched Healthy Controls (HC) on ToM and interpersonal functioning tasks. All participants completed the Revised Mind in the Eyes Task (MET), the Cognitive and Emotional Perspective Taking Task (CEPTT), and the Index of Peer Relations (IPR). Type I BD patients reported greater peer difficulties on the IPR compared to HC, and also performed more poorly on the MET and the cognitive condition of the CEPTT, but did not differ significantly on the emotional condition. There were no significant group differences between type II BD patients and HC. More impaired ToM performance was associated with poorer interpersonal functioning. Type I BD patients show deficits in the ability to understand another's mental state, irrespective of emotional valence. Deficits in understanding others' mental states could be an important treatment target for type I pediatric patients with BD. PMID:24461271

  16. Increased hexosaminidase activity in antipsychotic-induced extrapyramidal side effects: possible association with higher occurrence in bipolar disorder patients.

    PubMed

    Tunca, Zeliha; Resmi, Halil; Ozkara, H Asuman; Ciliv, Gönenc; Celtikci, Basak; Alptekin, Koksal; Ozerdem, Aysegul; Akdede, Berna Kivircik; Baykara, Burak; Birsoy, Bilge; Ergor, Gul

    2008-07-01

    Dystonic movements and Parkinsonism are frequently seen in gangliosidoses and these conditions have been reported to modify dopaminergic plasticity. We investigated whether the activity of hexosaminidase, a type-two ganglioside (GM2) degrading enzyme, correlates with drug-induced extrapyramidal system (EPS) side effects in psychiatric patients. We compared hexosaminidase activity in the lymphocytes of 29 EPS-positive patients, 13 EPS-negative patients, and 30 healthy volunteers. The activities of A and B isoforms of hexosaminidase were higher in EPS-positive patients than EPS-negative patients and healthy controls. Multivariate analysis suggested an interaction with increased B isoform activity and EPS side effects in female bipolar disorder patients. Higher levels of hexosaminidase enzyme activity may explain the frequent occurrence of antipsychotic-induced extrapyramidal side effects in mood disorder patients. PMID:18436361

  17. Acute renal failure induced by markedly decreased appetite secondary to a depressive episode after discontinuation of long-term lithium therapy in an elderly patient with bipolar disorder

    PubMed Central

    Okada, Akira

    2014-01-01

    Some elderly patients on chronic lithium therapy for bipolar disorder and their doctors may be faced with a therapeutic dilemma over whether or not to continue prescribing/taking lithium given their increased risk of reduced renal function. We present the case of a 78-year-old woman with bipolar disorder who discontinued lithium therapy due to increased risk factors for renal injury. After discontinuation, she experienced markedly decreased appetite secondary to a depressive episode, and developed acute renal failure, which subsequently progressed to a more advanced stage of chronic kidney disease. This case suggests that extreme care must be taken to prevent the recurrence of depression in elderly patients with bipolar disorder who discontinue lithium therapy, even when they had been emotionally stable for a long time while receiving lithium. Medications other than lithium for bipolar disorder may be needed at the time lithium therapy is discontinued. PMID:24835805

  18. Treating the elderly diabetic patient: special considerations

    PubMed Central

    Kezerle, Louise; Shalev, Leah; Barski, Leonid

    2014-01-01

    The prevalence of diabetes is rising in the >65 year-old group. The challenge of defining the goals of therapy arises from the heterogeneity of the aging process and the sparse clinical data in this patient population. In light of these challenges, the clinician should be aware of the pitfalls of caring for the older diabetic patient and prioritize an individualized treatment plan to ensure an optimal glycemic control, without placing the patient at unnecessary risk. We present a review of the current guidelines and literature that deal specifically with the treatment of the older diabetic patient in order to establish the principles of treatment in this age group and help the clinician make decisions regarding the care of these patients. PMID:25210468

  19. Treating a physician patient with psychosis.

    PubMed

    Freedman, Jacob L; Crow, Fredrick F; Gutheil, Thomas G; Sanchez, Luis T; Suzuki, Joji

    2012-06-01

    The authors present a case of a psychotic female patient who is a former graduate of a locally prestigious medical school and has subsequently been diagnosed with schizophrenia. The patient entered treatment in an outpatient clinic following discharge from her 11th hospitalization. This hospitalization was initiated after the patient's physician friend had called the police and notified them that the patient was significantly disorganized to warrant further evaluation. Treatment was characterized by significant transference and counter-transference reactions amongst her clinicians - both treatment-promoting and treatment-interfering - based on her status as a physician. The problem of insight was a significant hurdle in the treatment of the patient as her medical knowledge of mental illness was substantially greater than her insight into her own mental illness. Throughout treatment, a number of medical-legal and ethical issues arose. Initially, the question was raised as to the legality of the actions by the patient's friend-having made a clinical assessment without having a clinical role in the patient's care. As the patient's clinical status improved and she sought to re-enter the medical field as a resident, new medical legal issues surfaced. What were the roles of the patient's treaters in maintaining confidentiality and simultaneously ensuring the safety of patients that the psychotic physician might care for? This case highlights the universality of psychiatric vulnerability. Insight in psychosis as well as the transference and counter-transference issues involved in caring for a psychotic physician are discussed. Additionally, a thorough medical-legal discussion addresses the various complexities of caring for a psychotic physician. PMID:22813669

  20. Treatment response in relation to subthreshold bipolarity in patients with major depressive disorder receiving antidepressant monotherapy: a post hoc data analysis (KOMDD study)

    PubMed Central

    Park, Young-Min; Lee, Bun-Hee

    2016-01-01

    Background The aim of this observational study was to determine whether subthreshold bipolarity affects treatment response and remission in patients with major depressive disorder receiving antidepressant (AD) monotherapy over a 6-month follow-up period. Methods Seventy-eight patients with major depressive disorder were stratified into two subgroups according to the presence of subthreshold bipolarity, identified using the Korean version of the Mood Disorder Questionnaire (K-MDQ), which classifies patients as positive for a screening of bipolarity based on the cutoff for the total K-MDQ score (ie, 7 points). They received AD monotherapy such as escitalopram, sertraline, paroxetine, or tianeptine for 6 months. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Scale, and Beck Scale for Suicide Ideation were applied at baseline, 1 week, 3 weeks, 2 months, 3 months, and 6 months. Results The mean HAMD, BDI, and Beck Scale for Suicide Ideation scores were higher in the bipolarity group than in the nonbipolarity group at 3 weeks. The mean BDI score was also higher in the bipolarity group than in the nonbipolarity group at 6 months. Evaluation of the ratio of improvement for each scale revealed different patterns of percentage changes between the two groups over the 6-month follow-up period. Furthermore, the response and remission rates (as assessed using BDI and HAMD scores) were higher in the nonbipolarity group than in the bipolarity group, with the exception of HAMD scores at the 3-week follow-up time point. Conclusion The findings of this study showed that depressed patients with bipolarity had a worse response to AD monotherapy than did those without bipolarity. PMID:27274258

  1. A comparative study on psycho-socio-demographic and clinical profile of patients with bipolar versus unipolar depression

    PubMed Central

    Nisha, A.; Sathesh, V.; Punnoose, Varghese P.; Varghese, P. Joseph

    2015-01-01

    Background: Several studies have revealed significant differences between bipolar (BP) and unipolar depression (UP). Misdiagnosing BP depression results in suboptimal symptom resolution, induction of manic switch, mixed state, or accelerated cycling. This study compares various psycho-socio-demographic, longitudinal course, and phenomenological factors associated with BP and UP depression. Materials and Methods: We compared 30 UP and 30 BP depression patients using a specially designed intake proforma, International Classification of Diseases-10 diagnostic criteria for research, Hamilton Rating Scale for Depression-21 (HAMD-21), Hypomania Checklist-32 Questionnaire (HCL-32), Brief psychiatric rating scale (BPRS), and Kuppuswami's socioeconomic status scale. Results: BP depression group consisted of mostly males, with earlier age of onset of illness, longer illness duration, frequent episodes, hospitalizations and psychotic symptoms. The total HAM-D score and 4 HAM-D item scores–psychomotor retardation, insight, diurnal variation of symptoms and its severity, and paranoid symptoms were significantly higher in this group. Binary logistic regression identified the age of onset, the total duration of illness, frequency of affective episodes, and presence of delusions as predictors of bipolarity (odds ratio = 1.327; 1.517; 0.062; 0.137). Conclusions: Identification of clinical markers of bipolarity from large scale prospective studies is needed. PMID:26813699

  2. The Working Alliance Between Patients With Bipolar Disorder and the Nurse: Helpful and Obstructive Elements During a Depressive Episode From the Patients' Perspective.

    PubMed

    Stegink, Eva E; van der Voort, Trijntje Y G Nienke; van der Hooft, Truus; Kupka, Ralph W; Goossens, Peter J J; Beekman, Aartjan T F; van Meijel, Berno

    2015-10-01

    Despite treatment, many patients with bipolar disorder experience impaired functioning and a decreased quality of life. Optimal collaboration between patient and mental health care providers could enhance treatment outcomes. The goal of this qualitative study, performed in a trial investigating the effect of collaborative care, was to gain more insight in patients' experiences regarding the helpful and obstructive elements of the working alliance between the patient recovering from a depressive episode and their nurse. Three core themes underpinned the nurses' support during recovery: a safe and supportive environment, assistance in clarifying thoughts and feelings, and support in undertaking physical activities. PMID:26397431

  3. How I treat patients with massive hemorrhage.

    PubMed

    Johansson, Pär I; Stensballe, Jakob; Oliveri, Roberto; Wade, Charles E; Ostrowski, Sisse R; Holcomb, John B

    2014-11-13

    Massive hemorrhage is associated with coagulopathy and high mortality. The transfusion guidelines up to 2006 recommended that resuscitation of massive hemorrhage should occur in successive steps using crystalloids, colloids, and red blood cells (RBCs) in the early phase and plasma and platelets in the late phase. With the introduction of the cell-based model of hemostasis in the mid-1990s, our understanding of the hemostatic process and of coagulopathy has improved. This has contributed to a change in resuscitation strategy and transfusion therapy of massive hemorrhage along with an acceptance of the adequacy of whole blood hemostatic tests to monitor these patients. Thus, in 2005, a strategy aiming at avoiding coagulopathy by proactive resuscitation with blood products in a balanced ratio of RBC:plasma:platelets was introduced, and this has been reported to be associated with reduced mortality in observational studies. Concurrently, whole blood viscoelastic hemostatic assays have gained acceptance by allowing a rapid and timely identification of coagulopathy along with enabling an individualized, goal-directed transfusion therapy. These strategies joined together seem beneficial for patient outcome, although final evidence on outcome from randomized controlled trials are lacking. We present how we in Copenhagen and Houston, today, manage patients with massive hemorrhage. PMID:25293771

  4. Maintenance electroconvulsive therapy in a patient with multiple system atrophy and bipolar disorder.

    PubMed

    Obiora, Onwuameze; McCormick, Laurie May; Karim, Yasser; Gonzales, Pedro; Beeghly, James

    2012-06-01

    Multiple system atrophy is a rapidly progressive neurodegenerative disorder with no known cure. It is a clinical diagnosis with no confirmation available other than brain biopsy after death. We report the successful treatment of multiple system atrophy co-occurring with bipolar disorder in a 62-year-old man using electroconvulsive therapy. PMID:22622294

  5. An Integrated Risk Reduction Intervention can reduce body mass index in individuals being treated for bipolar I disorder: results from a randomized trial

    PubMed Central

    Frank, Ellen; Wallace, Meredith L; Hall, Martica; Hasler, Brant; Levenson, Jessica C; Janney, Carol A; Soreca, Isabella; Fleming, Matthew C; Buttenfield, Joan; Ritchey, Fiona C; Kupfer, David J

    2014-01-01

    Objectives We conducted a randomized, controlled trial comparing the efficacy of an Integrated Risk Reduction Intervention (IRRI) to a control condition with the objective of improving mood stability and psychosocial functioning by reducing cardiometabolic risk factors in overweight/obese patients with bipolar I disorder. Methods A total of 122 patients were recruited from our outpatient services and randomly allocated to IRRI (n = 61) or psychiatric care with medical monitoring (n = 61). Individuals allocated to IRRI received psychiatric treatment and assessment, medical monitoring by a nurse, and a healthy lifestyle program from a lifestyle coach. Those allocated to the control condition received psychiatric treatment and assessment and referral, if indicated, for medical problems. A mixed-effects model was used to examine the impact of the interventions on body mass index (BMI). Exploratory moderator analyses were used to characterize those individuals likely to benefit from each treatment approach. Results Analyses were conducted on the IRRI (n = 58) and control (n = 56) participants with ≥ 1 study visit. IRRI was associated with significantly greater rate of decrease in BMI (d = −0.51, 95% confidence interval: −0.91 to −0.14). Three variables (C-reactive protein, total cholesterol, and instability of total sleep time) contributed to a combined moderator of faster decrease in BMI with IRRI treatment. Conclusions Overweight/obese patients with bipolar disorder can make modest improvements in BMI, even when taking medications with known potential for weight gain. Our finding that a combination of three baseline variables provides a profile of patients likely to benefit from IRRI will need to be tested further to evaluate its utility in clinical practice. PMID:25495748

  6. Assessing and Treating the Patient with Acute Psychotic Disorders.

    PubMed

    Jensen, Lisa; Clough, Rebecca

    2016-06-01

    Patients with acute psychosis often present to emergency departments. Management of acute agitation and psychosis can be a challenge for the staff. Medical stabilization, appropriate assessment, and diagnosis are important. Verbal de-escalation and other psychosocial interventions are helpful in creating a safe and therapeutic environment. Psychiatric and emergency room nurses are poised to treat patients presenting with acute psychosis and must be knowledgeable of evidence-based approaches to treat these complex disorders. PMID:27229275

  7. Pregnancy in acromegaly patients treated with pegvisomant.

    PubMed

    van der Lely, A J; Gomez, Roy; Heissler, Joseph F; Åkerblad, Ann-Charlotte; Jönsson, Peter; Camacho-Hübner, Cecilia; Kołtowska-Häggström, Maria

    2015-08-01

    To summarize all available data on pregnancy outcome of acromegaly patients exposed to the growth hormone receptor antagonist pegvisomant (PEGV) during pregnancy as present in the Pfizer's Global Safety Database. Pfizer's Global Safety Database contains adverse event data obtained from the following sources: spontaneous reports, health authorities, Pfizer-sponsored post-marketing surveillance program (ACROSTUDY), customer engagement programs, and clinical studies, reported regardless of outcome. The safety database was searched up to 10th March 2014. From the 35 pregnancy cases, 27 involved maternal [mean age (range) 33.3 years (23-41) and 8 paternal (33.7 years (32-38)] PEGV exposure. Two female patients were reported with two pregnancy cases each. Fetal outcome was normal in 14 (4 paternal) of the 18 reported as live birth, while 4 cases (1 paternal) did not specify the birth outcome. At conception, PEGV mean dose (range) was 15.3 mg/d (4.3-30). In 3 cases of maternal exposure of the 18 cases reporting live birth, PEGV was continued throughout the pregnancy in a dose of 12.1 mg/d (10-15). In 5 cases (all maternal) an elective termination of the pregnancy was performed with no reported fetal abnormalities, 2 cases (maternal) reported a non-PEGV-related spontaneous abortion and in 1 maternal case an ectopic pregnancy occurred. In 9 cases (3 paternal), the fetal outcome was not reported. Three women reported gestational diabetes; one woman continued PEGV treatment during pregnancy. Although the number of reported pregnancies with exposure to PEGV is very small, the presented data reflect the largest series of data available to date and do not suggest adverse consequences of PEGV on pregnancy outcome. Nevertheless, it should be stressed that PEGV should not be used during pregnancy unless absolutely necessary. PMID:25542184

  8. Incidence of sarcoma in patients treated with fast neutrons

    SciTech Connect

    MacDougall, R. Hugh . E-mail: medical.dean@st-andrews.ac.uk; Kerr, Gillian R.; Duncan, William

    2006-11-01

    Purpose: The aim of this study is to report the incidence of soft tissue sarcoma in a large group of patients treated with fast neutrons. Methods: A systematic review was conducted of long-term follow-up after trials of fast neutron therapy for cancers at various sites. The study took place at Edinburgh Cancer Centre, Western General Hospital, Edinburgh, Scotland, United Kingdom. From 1977 to 1984, 620 patients were treated using fast neutrons in the MRC cyclotron unit in Edinburgh. Most of these were treated within randomized controlled trials. Follow-up was maintained in all except 2 patients, who left the area to return abroad. The main outcome measure was the incidence of new soft-tissue sarcomas during long-term follow-up. Results: Three cases of sarcoma, developing within the treatment volume, were observed in a small group of patients treated some years earlier using fast neutrons. This incidence was 111 times what would have been expected in the normal population and 15 times the incidence in a comparable photon-treated group of patients. Conclusion: The long-term incidence of sarcomas in patients previously treated with fast neutrons is significant.

  9. Treatment of Bipolar Disorder in the University Student Population

    ERIC Educational Resources Information Center

    Federman, Russ

    2011-01-01

    University counseling centers are faced with the challenge of effectively treating bipolar students while also utilizing brief treatment frameworks and managing high patient volumes. Potential destabilization, particularly within the elevated mood phase, poses significant behavioral management issues for university clinicians and administrators,…

  10. Bipolar disorder in general practice: challenges and opportunities.

    PubMed

    Piterman, Leon; Jones, Kay M; Castle, David J

    2010-08-16

    General practitioners are involved in the continuing care and shared care of patients with chronic mental illness, including bipolar disorder. Psychiatrists are particularly reliant on GPs to monitor and treat comorbidities as well as the psychiatric condition itself. Management of chronic mental illness is compromised by a number of factors, including problems with diagnosis, physical comorbidity, erratic attendance and poor compliance with treatment. Diagnosis of bipolar disorder is often delayed, and differential diagnoses to be considered include unipolar depression, anxiety disorder, drug and alcohol dependence, personality disorder, attention deficit hyperactivity disorder, and general medical and central nervous system diseases. New Medicare items have been introduced under the Better Access to Mental Health Care initiative. However, uptake for patients with chronic psychiatric illness, including bipolar disorder, is low. Patients with bipolar disorder may be prone to a range of comorbid psychological, social and physical problems, and GPs need to be vigilant to detect and manage comorbidity and social problems as part of the overall plan. This includes assistance with certification for sickness and unemployment benefits. GPs may become involved during crises affecting patients and this may pose significant problems for GPs who need to provide ongoing care following patient discharge from hospital. Despite these difficulties, opportunities exist for GPs to play a vital and ongoing role in the management of patients with bipolar disorder. PMID:20712554

  11. Important clinical features of atypical antipsychotics in acute bipolar depression that inform routine clinical care: a review of pivotal studies with number needed to treat.

    PubMed

    Gao, Keming; Yuan, Chengmei; Wu, Renrong; Chen, Jun; Wang, Zuowei; Fang, Yiru; Calabrese, Joseph R

    2015-10-01

    English-language literature cited in MEDLINE from January, 1980 to October 30, 2014 was searched by using terms of antipsychotic, generic and brand names of atypical antipsychotics, "bipolar depression/bipolar disorder", "placebo", and "trial". The parameters of response (≥50% improvement on MADRS, Montgomery-Asberg Depression Rating Scale total score), remission (either ≤12 or 8 on MADRS total score at endpoint), discontinuation due to adverse events (DAEs), somnolence, ≥7% weight gain, overall extrapyramidal side-effects (EPSs), and akathisia, were extracted from originally published primary outcome papers. The number needed to treat to benefit (NNT) for response and remission or harm (NNH) for DAEs or other side effects relative to placebo were estimated and presented with the estimate and 95% confidence interval. Olanzapine monotherapy, olanzapine-fluoxetine combination (OFC), quetiapine-IR monotherapy, quetiapine-XR monotherapy, lurasidone monotherapy, and lurasidone adjunctive therapy were superior to placebo with NNTs for responses of 11-12, 4, 7-8, 4, 4-5, and 7, and NNTs for remission of 11-12, 4, 5-11, 7, 6-7, and 6, respectively. There was no significant difference between OFC and lamotrigine, and between aripiprazole or ziprasidone and placebo in response and remission. Olanzapine monotherapy, quetiapine-IR, quetiapine-XR, aripiprazole, and ziprasidone 120-160 mg/day had significantly increased risk for DAEs with NNHs of 24, 8-14, 9, 12, and 10, respectively. For somnolence, quetiapine-XR had the smallest NNH of 4. For ≥7% weight gain, olanzapine monotherapy and OFC had the smallest NNHs with both of 5. For akathisia, aripiprazole had the smallest NNH of 5. These findings suggest that among the FDA-approved agents including OFC, quetiapine-IR and -XR, lurasidone monotherapy and adjunctive therapy to a mood stabilizer, the differences in the NNTs for response and remission are small, but the differences in NNHs for DAEs and common side

  12. Nicotine dependence and psychosis in Bipolar disorder and Schizoaffective disorder, Bipolar type.

    PubMed

    Estrada, Elena; Hartz, Sarah M; Tran, Jeffrey; Hilty, Donald M; Sklar, Pamela; Smoller, Jordan W; Pato, Michele T; Pato, Carlos N

    2016-06-01

    Patients with Bipolar disorder smoke more than the general population. Smoking negatively impacts mortality and clinical course in Bipolar disorder patients. Prior studies have shown contradictory results regarding the impact of psychosis on smoking behavior in Bipolar disorder. We analyzed a large sample of Bipolar disorder and Schizoaffective disorder, Bipolar Type patients and predicted those with a history of psychosis would be more likely to be nicotine dependent. Data from subjects and controls were collected from the Genomic Psychiatry Cohort (GPC). Subjects were diagnosed with Bipolar disorder without psychosis (N = 610), Bipolar disorder with psychosis (N = 1544). Participants were classified with or without nicotine dependence. Diagnostic groups were compared to controls (N = 10065) using logistic regression. Among smokers (N = 6157), those with Bipolar disorder had an increased risk of nicotine dependence (OR = 2.5; P < 0.0001). Patients with Bipolar disorder with psychosis were more likely to be dependent than Bipolar disorder patients without psychosis (OR = 1.3; P = 0.03). Schizoaffective disorder, Bipolar Type patients had more risk of nicotine dependence when compared to Bipolar disorder patients with or without psychosis (OR = 1.2; P = 0.02). Bipolar disorder patients experiencing more severity of psychosis have more risk of nicotine dependence. © 2015 Wiley Periodicals, Inc. PMID:26467098

  13. Significant Treatment Effect of Bupropion in Patients With Bipolar Disorder but Similar Phase-Shifting Rate as Other Antidepressants: A Meta-Analysis Following the PRISMA Guidelines.

    PubMed

    Li, Dian-Jeng; Tseng, Ping-Tao; Chen, Yen-Wen; Wu, Ching-Kuan; Lin, Pao-Yen

    2016-03-01

    Bupropion is widely used for treating bipolar disorder (BD), and especially those with depressive mood, based on its good treatment effect, safety profile, and lower risk of phase shifting. However, increasing evidence indicates that the safety of bupropion in BD patients may not be as good as previously thought. The aim of this study was to summarize data on the treatment effect and safety profile of bupropion in the treatment of BD via a meta-analysis. Electronic search through PubMed and ClinicalTrials.gov was performed. The inclusion criteria were: (i) studies comparing changes in disease severity before and after bupropion treatment or articles comparing the treatment effect of bupropion in BD patients with those receiving other standard treatments; (ii) articles on clinical trials in humans. The exclusion criteria were (i) case reports/series, and (ii) nonclinical trials. All effect sizes from 10 clinical trials were pooled using a random effects model. We examined the possible confounding variables using meta-regression and subgroup analysis. Bupropion significantly improved the severity of disease in BD patients (P < 0.001), and the treatment effect was similar to other antidepressants/standard treatments (P = 0.220). There were no significant differences in the dropout rate (P = 0.285) and rate of phase shifting (P = 0.952) between BD patients who received bupropion and those who received other antidepressants. We could not perform a detailed meta-analysis of every category of antidepressant, nor could we rule out the possible confounding effect of concurrent psychotropics or include all drug side effects. Furthermore, the number of studies recruited in the meta-analysis was relatively small. Our findings reconfirm the benefits of bupropion for the treatment of bipolar depression, which are similar to those of other antidepressants. However, the rate of phase shifting with bupropion usage was not as low compared to other antidepressants as

  14. Posttraumatic Stress Disorder, Depression, and Health-related Quality of Life in Patients with Bipolar Disorder: Review and New Data from a Multi-Site Community Clinic Sample

    PubMed Central

    Bajor, Laura A.; Lai, Zongshan; Goodrich, David E.; Miller, Christopher J.; Penfold, Robert B.; Kim, Hyungjin Myra; Kilbourne, Amy M.; Bauer, Mark S.

    2012-01-01

    Background Evidence suggests that patients with bipolar disorder have an elevated risk for comorbid posttraumatic stress disorder (PTSD) compared to those without a bipolar diagnosis. Although bipolar disorder is associated with decreased health-related quality of life (HRQOL), it is unclear whether comorbid PTSD interacts to affect HRQOL. Method Baseline data from a multi-site study of patients with bipolar disorder were analyzed. Patient surveys ascertained clinical and demographic information, including physical and mental HRQOL based on the SF-12, mood symptoms (PHQ-9, Internal State Scale), and self-reported co-occurring conditions including PTSD. Results Overall (N=384), 43.5% of patients self-reported co-occurring PTSD. Patients with PTSD had lower physical and mental HRQOL scores compared to those without PTSD (mean (SD) for those with and without PTSD, respectively): Mental Component Scale score 30.51 (8.22) and 32.86 (8.35); Physical Component Scale score 35.56 (7.77) and 37.21 (7.20). After adjusting for demographic and clinical factors including mood symptoms, multivariable linear regression analyses revealed that PTSD was no longer significantly associated with physical or mental HRQOL; however, depressive symptoms were independently associated with mental HRQOL (Beta −0.63, p<0.01). Conclusion Depressive symptoms may explain the association between PTSD and mental HRQOL. Clinicians working with these patients will want to emphasize treatment of depression as important towards improving HRQOL for this group. PMID:23021820

  15. Bipolar Disorder.

    ERIC Educational Resources Information Center

    Spearing, Melissa

    Bipolar disorder, a brain disorder that causes unusual shifts in a person's mood, affects approximately one percent of the population. It commonly occurs in late adolescence and is often unrecognized. The diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and when possible, family history. Thoughts of suicide are…

  16. Bipolar Disorder

    MedlinePlus

    ... or digestive problems Problems sleeping, or wanting to sleep all of the time Feeling tired all of the time Thoughts about death and suicide Causes & Risk Factors What causes bipolar disorder? Bipolar disorder may be caused by a chemical imbalance in the brain. It sometimes runs in ...

  17. Intrahepatic Flow Redistribution in Patients Treated with Radioembolization

    SciTech Connect

    Spreafico, Carlo Morosi, Carlo; Maccauro, Marco; Romito, Raffaele; Lanocita, Rodolfo Civelli, Enrico M.; Sposito, Carlo Bhoori, Sherrie; Chiesa, Carlo; Frigerio, Laura F.; Lorenzoni, Alice; Cascella, Tommaso Marchianò, Alfonso; Mazzaferro, Vincenzo

    2015-04-15

    IntroductionIn planning Yttrium-90 ({sup 90}Y)-radioembolizations, strategy problems arise in tumours with multiple arterial supplies. We aim to demonstrate that tumours can be treated via one main feeding artery achieving flow redistribution by embolizing accessory vessels.MethodsOne hundred {sup 90}Y-radioembolizations were performed on 90 patients using glass microspheres. In 19 lesions/17 patients, accessory branches were found feeding a minor tumour portion and embolized. In all 17 patients, the assessment of the complete perfusion was obtained by angiography and single photon emission computerized tomography–computerized tomography (SPECT–CT). Dosimetry, toxicity, and tumor response rate of the patients treated after flow redistribution were compared with the 83 standard-treated patients. Seventeen lesions in 15 patients with flow redistribution were chosen as target lesions and evaluated according to mRECIST criteria.ResultsIn all patients, the complete tumor perfusion was assessed immediately before radioembolization by angiography in all patients and after the {sup 90}Y-infusion by SPECT–CT in 15 of 17 patients. In the 15 assessable patients, the response rate in their 17 lesions was 3 CR, 8 PR, and 6 SD. Dosimetric and toxicity data, as well tumour response rate, were comparable with the 83 patients with regular vasculature.ConclusionsAll embolization procedures were performed successfully with no complications, and the flow redistribution was obtained in all cases. Results in term of toxicity, median dose administered, and radiological response were comparable with standard radioembolizations. Our findings confirmed the intratumoral flow redistribution after embolizing the accessory arteries, which makes it possible to treat the tumour through its single main feeding artery.

  18. Bipolar disorder.

    PubMed

    Grande, Iria; Berk, Michael; Birmaher, Boris; Vieta, Eduard

    2016-04-01

    Bipolar disorder is a recurrent chronic disorder characterised by fluctuations in mood state and energy. It affects more than 1% of the world's population irrespective of nationality, ethnic origin, or socioeconomic status. Bipolar disorder is one of the main causes of disability among young people, leading to cognitive and functional impairment and raised mortality, particularly death by suicide. A high prevalence of psychiatric and medical comorbidities is typical in affected individuals. Accurate diagnosis of bipolar disorder is difficult in clinical practice because onset is most commonly a depressive episode and looks similar to unipolar depression. Moreover, there are currently no valid biomarkers for the disorder. Therefore, the role of clinical assessment remains key. Detection of hypomanic periods and longitudinal assessment are crucial to differentiate bipolar disorder from other conditions. Current knowledge of the evolving pharmacological and psychological strategies in bipolar disorder is of utmost importance. PMID:26388529

  19. The microtubule-associated molecular pathways may be genetically disrupted in patients with Bipolar Disorder. Insights from the molecular cascades.

    PubMed

    Drago, Antonio; Crisafulli, Concetta; Sidoti, Antonina; Calabrò, Marco; Serretti, Alessandro

    2016-01-15

    Bipolar Disorder is a severe disease characterized by pathological mood swings from major depressive episodes to manic ones and vice versa. The biological underpinnings of Bipolar Disorder have yet to be defined. As a consequence, pharmacological treatments are suboptimal. In the present paper we test the hypothesis that the molecular pathways involved with the direct targets of lithium, hold significantly more genetic variations associated with BD. A molecular pathway approach finds its rationale in the polygenic nature of the disease. The pathways were tested in a sample of ∼ 7,000 patients and controls. Data are available from the public NIMH database. The definition of the pathways was conducted according to the National Cancer Institute (http://pid.nci.nih.gov/). As a result, 3 out of the 18 tested pathways related to lithium action resisted the permutation analysis and were found to be associated with BD. These pathways were related to Reelin, Integrins and Aurora. A pool of genes selected from the ones linked with the above pathways was further investigated in order to identify the fine molecular mechanics shared by our significant pathways and also their link with lithium mechanism of action. The data obtained point out to a possible involvement of microtubule-related mechanics. PMID:26551401

  20. Stratifying Risk for Renal Insufficiency Among Lithium-Treated Patients: An Electronic Health Record Study.

    PubMed

    Castro, Victor M; Roberson, Ashlee M; McCoy, Thomas H; Wiste, Anna; Cagan, Andrew; Smoller, Jordan W; Rosenbaum, Jerrold F; Ostacher, Michael; Perlis, Roy H

    2016-03-01

    Although lithium preparations remain first-line treatment for bipolar disorder, risk for development of renal insufficiency may discourage their use. Estimating such risk could allow more informed decisions and facilitate development of prevention strategies. We utilized electronic health records from a large New England health-care system between 2006 and 2013 to identify patients aged 18 years or older with a lithium prescription. Renal insufficiency was identified using the presence of renal failure by ICD9 code or laboratory-confirmed glomerular filtration rate below 60 ml/min. Logistic regression was used to build a predictive model in a random two-thirds of the cohort, which was tested in the remaining one-third. Risks associated with aspects of pharmacotherapy were also examined in the full cohort. We identified 1445 adult lithium-treated patients with renal insufficiency, matched by risk set sampling 1 : 3 with 4306 lithium-exposed patients without renal insufficiency. In regression models, features associated with risk included older age, female sex, history of smoking, history of hypertension, overall burden of medical comorbidity, and diagnosis of schizophrenia or schizoaffective disorder (p<0.01 for all contrasts). The model yielded an area under the ROC curve exceeding 0.81 in an independent testing set, with 74% of renal insufficiency cases among the top two risk quintiles. Use of lithium more than once daily, lithium levels greater than 0.6 mEq/l, and use of first-generation antipsychotics were independently associated with risk. These results suggest the possibility of stratifying risk for renal failure among lithium-treated patients. Once-daily lithium dosing and maintaining lower lithium levels where possible may represent strategies for reducing risk. PMID:26294109

  1. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario.

    PubMed

    Vaid, Haris M; Camacho, Ximena; Granton, John T; Mamdani, Muhammad M; Yao, Zhan; Singh, Samantha; Juurlink, David N; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96-$747) for those who survived and $2,021 (IQR $993-$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  2. The Characteristics of Treated Pulmonary Arterial Hypertension Patients in Ontario

    PubMed Central

    Vaid, Haris M.; Camacho, Ximena; Granton, John T.; Mamdani, Muhammad M.; Yao, Zhan; Singh, Samantha; Juurlink, David N.; Gomes, Tara

    2016-01-01

    Background. There are no Canadian prevalence studies on pulmonary arterial hypertension (PAH) to date. We described the characteristics of treated PAH patients and the healthcare utilization and costs associated with PAH in a population of public drug plan beneficiaries in Ontario, Canada. Methods. A retrospective cross-sectional analysis was conducted between April 2010 and March 2011 to identify treated PAH patients using population-based health administrative databases. We investigated demographic and clinical characteristics of treated PAH patients and conducted a cohort study to determine treatment patterns, healthcare utilization, and associated costs, over a one-year follow-up period (March 2012). Results. We identified 326 treated PAH cases in Ontario's publicly funded drug plan. Overall mean age was 59.4 years (±20.3 years) and over 77% of cases were women (n = 251). Combination therapy was used to treat 22.9% (n = 69) of cases, costing an average of $4,569 (SD $1,544) per month. Median monthly healthcare costs were $264 (IQR $96–$747) for those who survived and $2,021 (IQR $993–$6,399) for those who died over a one-year period, respectively (p < 0.01). Conclusions. PAH care in Ontario is complex and has high healthcare costs. This data may help guide towards improved patient management. PMID:27445555

  3. Options for pharmacological treatment of refractory bipolar depression.

    PubMed

    Tondo, Leonardo; Vázquez, Gustavo H; Baldessarini, Ross J

    2014-02-01

    Bipolar disorders of types I and II, even when treated by currently standard options, show a marked excess of depressive morbidity. Treated, type I patients in mid-course or from the onset of illness are ill, overall, 50 % of weeks of follow-up, and 75 % of that unresolved morbidity is depressive. Currently widely held impressions are that bipolar depression typically is poorly responsive to antidepressants, that treatment-resistant depression (TRD) is characteristic of the disorder, and that risk of mania with antidepressant treatment is very high. However, none of these views is supported consistently by available research. TRD may be more prevalent in bipolar than unipolar mood disorders. Relatively intense research attention is directed toward characteristics and treatments of TRD in unipolar depression, but studies of bipolar TRD are uncommon. We found only five controlled trials, plus 10 uncontrolled trials, providing data on a total of 13 drug treatments, all of which involved one or two trials, in 87 % as add-ons to complex, uncontrolled regimens. In two controlled trials, ketamine was superior to placebo but it is short-acting and not orally active; pramipexole was weakly superior to placebo in one controlled trial; three other drugs failed to outperform controls. Other pharmacotherapies are inadequately evaluated and nonpharmacological options are virtually untested in bipolar TRD. The available research supports the view that antidepressants may be effective in bipolar depression provided that currently agitated patients are excluded, that risk of mania with antidepressants is only moderately greater than risk of spontaneous mania, and that bipolar TRD is not necessarily resistant to all treatments. PMID:24425269

  4. Bipolar Disorder: A Daughter's Experience.

    PubMed

    Khare, Satya Rashi

    2016-09-01

    My father suffered from bipolar disorder. His illness placed an enormous strain on our relationship which, for the most part, was filled with turbulence. Although our family physician played an integral role in supporting my parents throughout the disease, I did not receive the same support and suffered as a consequence. In this essay, I describe my father's manic and major depressive episodes, as well as my emotions that resulted from the experience. Treating mental illness goes beyond just treating the patient but rather encompasses the family as a whole. My relationship with my father may have been different had I learned effective coping strategies through the support of my family physician. PMID:27621165

  5. State-related differences in the level of psychomotor activity in patients with bipolar disorder - Continuous heart rate and movement monitoring.

    PubMed

    Faurholt-Jepsen, Maria; Brage, Søren; Vinberg, Maj; Kessing, Lars Vedel

    2016-03-30

    Measuring changes in psychomotor activity is a potential tool in the monitoring of the course of affective states in bipolar disorder. Previous studies have been cross-sectional and only some have used objective measures. The aim was to investigate state-related differences in objectively-measured psychomotor activity in bipolar disorder. During a 12 weeks study, repeated measurements of heart rate and movement monitoring over several days were collected during different affective states from 19 outpatients with bipolar disorder. Outcomes included activity energy expenditure (AEE) and trunk acceleration (ACC). Symptoms were clinically assessed using Hamilton Depression Rating Scale (HDRS-17) and Young Mania Rating Scale (YMRS). Compared to patients in a euthymic state, patients in a manic state had significantly higher AEE. Compared to patients in a depressive state, patients in a manic state had significantly higher ACC and AEE. There was a significant diurnal variation in ACC and AEE between affective states. Finally, there was a significant correlation between the severity of manic symptoms and ACC and AEE, respectively. This first study measuring psychomotor activity during different affective states using a combined heart rate and movement sensor supports that psychomotor activity is a core symptom in bipolar disorder that is altered during affective states. PMID:26832835

  6. Operative Treatment of Bipolar Clavicular Dislocation: A Case Report

    PubMed Central

    Schuh, Alexander; Thonse, Chirag Narayana; Schmickal, Thomas; Kleine, Ludwig

    2012-01-01

    Introduction: Simultaneous bipolar dislocation of the clavicle is uncommon and unusual, although it has been documented as panclavicular dislocation, floating clavicle, and complete dislocation of the clavicle. A review of the recent literature indicated that most bipolar clavicular dislocations have been treated non-operatively. Case Report: We report the case of a 23 year polytrauma patient with bipolar dislocation of the right clavicle. Patient presented to us 2 weeks post injury and had an unstable corao-clavicular joint. On radiographic assessment a simultaneous dislocation of the coraco-clavicular and sterno-clavicular joints of right side was diagnosed. In view of the unstable condition of the right clavicle, young age of the patient, requirement of high physical activity a decision for operative treatment for clavicle dislocation was taken. Patient was treated surgically with open reduction and tension band wiring with good result. Conclusion: Although bipolar dislocation of the clavicle are rare a high index of suspicion will avoid missed diagnosis. Open reduction and internal fixation is a good option in young patients and gives good short term result.

  7. Evaluation of the orofacial lesions in treated leprosy patients

    PubMed Central

    Pooja, VK; Vanishree, M; Ravikumar, Shamala; Koneru, Anila; Hunasgi, Santhosh; Surekha, R

    2014-01-01

    Background: Leprosy is primarily a disease of developmental countries. About 4 million people have or are disabled by leprosy. Eighty-six percent of leprosy patients reside in Southeast Asia and Brazil. India accounts for up to 70% of total cases. Aim: To evaluate the incidence of orofacial lesions in treated leprosy patients. Materials and Methods: Thirty treated leprosy patients were examined clinically and the percentage of orofacial lesions were evaluated. Results: On evaluating the orofacial lesions, incidence of hypopigmentation on face and oral mucosa were highest (63%) followed by depressed nasal bridge and fissured tongue (33%). The incidence of crenated tongue was seen to be the lowest (3.3%). Conclusion: Orofacial lesions in leprosy patients develop insidiously, generally are asymptomatic and are secondary to nasal changes. Oral lesions may contribute to the diagnosis of the disease and be attributed to involvement of Mycobacterium leprae. PMID:25948993

  8. Pediatric Bipolar Disorder: Combination Pharmacotherapy, Adverse Effects, and Treatment of High-Risk Youth.

    PubMed

    Chang, Kiki D

    2016-01-01

    Treating bipolar disorder in pediatric patients is challenging because data from rigorous trials of pharmacotherapy in this population are still not plentiful enough. Furthermore, the treatment of children and adolescents is complicated by the frequent need to combine pharmacotherapies to address all bipolar symptoms as well as this population's elevated risk for experiencing side effects. Additionally, young patients with depressive episodes who are at high risk for developing bipolar disorder need careful treatment to prevent or delay the emergence of mania. Despite these challenges, clinicians should evaluate the existing pediatric literature, extrapolate evidence obtained from adult patients, and draw from clinical experience to guide treatment decisions for children and adolescents with bipolar disorder. PMID:27570929

  9. Manic episode after ventricular-peritoneal shunt replacement in a patient with radiation-induced hydrocephalus: the role of lifetime subthreshold bipolar features.

    PubMed

    Callari, Antonio; Mantua, Valentina; Miniati, Mario; Benvenuti, Antonella; Mauri, Mauro; Dell'osso, Liliana

    2014-01-01

    We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient's history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement. PMID:24527253

  10. Manic Episode after Ventricular-Peritoneal Shunt Replacement in a Patient with Radiation-Induced Hydrocephalus: The Role of Lifetime Subthreshold Bipolar Features

    PubMed Central

    Callari, Antonio; Mantua, Valentina; Miniati, Mario; Benvenuti, Antonella; Mauri, Mauro; Dell'Osso, Liliana

    2014-01-01

    We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient's history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement. PMID:24527253

  11. Evidence-Based Pharmacologic Treatment of Pediatric Bipolar Disorder.

    PubMed

    Findling, Robert L

    2016-01-01

    Pharmacotherapy is an important component of treatment for children and adolescents with bipolar disorder. The body of evidence supporting safe and effective treatments in this population is growing. Available data provide information on the risks and benefits of pharmacologic agents used for acute manic, mixed, and depressive episodes as well as for maintenance treatment. Lithium, anticonvulsants, and antipsychotics comprise the armamentarium for treating pediatric bipolar disorder. When selecting treatment, clinicians must consider the efficacy and side effect profile of potential pharmacotherapies, as well as the patient's history, including the presence of comorbidities, in order to develop a treatment plan that will ensure optimal outcomes. PMID:27570928

  12. Psychiatrists' Perceptions and Practices in Treating Patients' Obesity

    ERIC Educational Resources Information Center

    Lichwala-Zyla, Christine; Price, James H.; Dake, Joseph A.; Jordan, Timothy; Price, Joy Ann

    2009-01-01

    Objective: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. Methods: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change…

  13. Mixture regression analysis on age at onset in bipolar disorder patients: investigation of the role of serotonergic genes.

    PubMed

    Manchia, Mirko; Zai, Clement C; Squassina, Alessio; Vincent, John B; De Luca, Vincenzo; Kennedy, James L

    2010-09-01

    Bipolar Disorder (BPD) is a complex psychiatric disease with a relevant underlying genetic basis. HTR2A T102C, HTR2C Cys23Ser, SLC6A4 5-HTTLPR and rs25531 polymorphisms were genotyped in 230 BPD patients and inserted as covariates in a mixture regression model of age at onset (AAO). 5-HTTLPR polymorphism associated with early onset component under recessive and additive model. HTR2A T102C, HTR2C Cys23Ser and 5-HTTLPR interaction terms associated with early onset component under dominant, recessive and additive model. These findings suggest a role of genes codifying for elements of the serotonergic system in influencing the AAO in BPD. PMID:20452754

  14. Ophthalmological outcomes of patients treated for pineal region tumors.

    PubMed

    Hankinson, Elizabeth V; Lyons, Christopher J; Hukin, Juliette; Cochrane, David D

    2016-05-01

    OBJECTIVE The ophthalmological outcomes of children treated for pineal tumors have received limited attention in the literature. METHODS This paper reviews the outcomes of 29 children treated for pineal and posterior third ventricular tumors in the contemporary era using chemotherapy, radiotherapy, and resection as defined by the histology and/or marker profile of the tumor. RESULTS At the time of diagnosis, all patients except 1 had hydrocephalus and all had ophthalmological involvement. Papilledema was found in 69% of patients. Seventy-five percent of patients had partial or complete Parinaud's syndrome, and diplopia or blurred vision was noted in the remaining patients. Visual acuity was impaired in 8 patients. Outcomes were dependent on the histology of the tumor and the treatment required. Those patients who did not requiring resection showed a lower rate of ophthalmological worsening during treatment and greater long-term improvement, in particular with respect to up-gaze palsy. Patients who underwent resection for postchemotherapy residual disease or primary resection showed greater worsening during treatment and lesser degrees of recovery. All patients with impaired visual acuity improved with treatment. CONCLUSIONS As the mortality of germ cell and other pineal tumors decreases, posttreatment morbidity remains, specifically that related to convergence nystagmus, accommodation, and diplopia. In addition to survival, ophthalmological morbidity should be reported in studies concerning the outcomes of treatment for pineal neoplasms. PMID:26799411

  15. Bipolar disorder and multiple sclerosis.

    PubMed

    Ybarra, Mariana Inés; Moreira, Marcos Aurélio; Araújo, Carolina Reis; Lana-Peixoto, Marco Aurélio; Teixeira, Antonio Lucio

    2007-12-01

    Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in this area is limited, studies assessing the nature of this association have focused on genetic aspects, adverse reaction to drugs and brain demyelinating lesions. Herein we report three patients with MS that also presented bipolar disorder. The coexistence of neurological and psychiatric symptoms in most MS relapses highlights the relevance of biological factors in the emergence of mood disorders in these patients. PMID:18345425

  16. The DRD3 Ser9Gly Polymorphism Predicted Metabolic Change in Drug-Naive Patients With Bipolar II Disorder

    PubMed Central

    Chang, Ting-Ting; Chen, Shiou-Lan; Chang, Yun-Hsuan; Chen, Po-See; Chu, Chun-Hsien; Chen, Shih-Heng; Huang, San-Yuan; Tzeng, Nian-Sheng; Wang, Liang-Jen; Wang, Tzu-Yun; Li, Chia-Ling; Chung, Yi-Lun; Hsieh, Tsai-Hsin; Lee, I-Hui; Chen, Kao-Ching; Yang, Yen-Kuang; Hong, Jau-Shyong; Lu, Ru-Band; Lee, Sheng-Yu

    2016-01-01

    Abstract Patients with bipolar II disorder (BDII) have a higher prevalence rate of metabolic disturbance. Whether BDII itself, in addition to its current standard treatment, is a risk factor for metabolic syndrome warrants additional study. The dopamine receptor D3 (DRD3) gene, one of the candidate genes for BDII, is also involved in the dopaminergic system. We investigated whether it is related to changes in the metabolic indices of patients with BDII given 12 weeks of standard treatment. Patients with a first diagnosis of BDII (n = 117) were recruited. Metabolic profiles (cholesterol, triglycerides, fasting serum glucose, body mass index) were measured at baseline and at 2, 8, and 12 weeks. The genotype of the DRD3 Ser9Gly polymorphism (rs6280) was determined. Multiple linear regressions with generalized estimating equation methods were used. Seventy-six (65.0%) patients completed the 12-week intervention. Significant differences in triglyceride change were associated with the DRD3 Ser9Gly genotype (P = 0.03). Patients with the Ser/Ser genotype had significantly smaller triglyceride increases and a lower risk of developing metabolic syndrome than did those with the Ser/Gly+Gly/Gly genotype. However, the associations between the DRD3 Ser9Gly polymorphism with changes in triglyceride level become nonsignificant after correcting for multiple comparisons. We conclude that the DRD3 Ser9Gly polymorphism is nominally associated with changes in triglycerides and metabolic syndrome after 12 weeks of standard BDII treatment. PMID:27310943

  17. Bipolar Disorder

    MedlinePlus

    ... health professional before making a commitment. Learn More Free Booklets and Brochures Bipolar Disorder: A brochure on ... in the public domain and available for use free of charge. Citation of the NIMH is appreciated. ...

  18. Bipolar battery

    DOEpatents

    Kaun, Thomas D.

    1992-01-01

    A bipolar battery having a plurality of cells. The bipolar battery includes: a negative electrode; a positive electrode and a separator element disposed between the negative electrode and the positive electrode, the separator element electrically insulating the electrodes from one another; an electrolyte disposed within at least one of the negative electrode, the positive electrode and the separator element; and an electrode containment structure including a cup-like electrode holder.

  19. Eye shielding for patients treated with total body irradiation.

    PubMed

    Reft, C; Rash, C; Dabrowski, J; Roeske, J C; Hallahan, D

    1996-01-01

    The incidence of cataracts in patients who have received total body irradiation (TBI) is about 20% and increases to 40% if the patient is treated for graft-versus-host disease. At our institution, all TBI patients are treated with two lateral opposed 24 MV photon fields. No attempt is usually made to shield the eyes during the TBI treatment because of the amount of lead required to adequately attenuate megavoltage photon beams, the difficulty in properly positioning an eye shield and the possibility of compromising the effectiveness of the treatment. However, we were asked to treat a TBI patient who is a professional pilot, and thus his livelihood is contingent upon maintaining perfect vision. A custom eye shield was constructed out of lead and ionization chamber and film measurements were performed under TBI conditions to determine the thickness and location of the eye block to optimize the competing effects of increased scatter and attenuation from the lead. Phantom data were also obtained for 6 MV irradiation for comparison with 24 MV. In-vivo patient and phantom measurements with thermoluminescent dosimeters showed that with visual positioning of the eye block the dose was reduced from 16 to 20% across the orbits of both eyes. PMID:8807606

  20. Corpus callosum area in patients with bipolar disorder with and without psychotic features: an international multicentre study

    PubMed Central

    Sarrazin, Samuel; d’Albis, Marc-Antoine; McDonald, Colm; Linke, Julia; Wessa, Michèle; Phillips, Mary; Delavest, Marine; Emsell, Louise; Versace, Amelia; Almeida, Jorge; Mangin, Jean-François; Poupon, Cyril; Le Dudal, Katia; Daban, Claire; Hamdani, Nora; Leboyer, Marion; Houenou, Josselin

    2015-01-01

    Background Previous studies have reported MRI abnormalities of the corpus callosum (CC) in patients with bipolar disorder (BD), although only a few studies have directly compared callosal areas in psychotic versus nonpsychotic patients with this disorder. We sought to compare regional callosal areas in a large international multicentre sample of patients with BD and healthy controls. Methods We analyzed anatomic T1 MRI data of patients with BD-I and healthy controls recruited from 4 sites (France, Germany, Ireland and the United States). We obtained the mid-sagittal areas of 7 CC subregions using an automatic CC delineation. Differences in regional callosal areas between patients and controls were compared using linear mixed models (adjusting for age, sex, handedness, brain volume, history of alcohol abuse/dependence, lithium or antipsychotic medication status, symptomatic status and site) and multiple comparisons correction. We also compared regional areas of the CC between patients with BD with and without a history of psychotic features. Results We included 172 patients and 146 controls in our study. Patients with BD had smaller adjusted mid-sagittal CC areas than controls along the posterior body, the isthmus and the splenium of the CC. Patients with a positive history of psychotic features had greater adjusted area of the rostral CC region than those without a history of psychotic features. Limitations We found small to medium effect sizes, and there was no calibration technique among the sites. Conclusion Our results suggest that BD with psychosis is associated with a different pattern of interhemispheric connectivity than BD without psychosis and could be considered a relevant neuroimaging subtype of BD. PMID:26151452

  1. Hearing Loss in Patients with Shunt-Treated Hydrocephalus.

    PubMed

    Panova, Margarita V; Geneva, Ina E; Madjarova, Kalina I; Bosheva, Miroslava N

    2015-01-01

    Hearing loss is a common manifestation of the long-term complications in patients with shunt treated hydrocephalus along with motor development disturbance, cognitive and visual impairment, epilepsy and endocrine disorders. The aim of the present study was to investigate the alterations of hearing in patients with shunt treated hydrocephalus of non-tumor etiology and at least one year after implantation of ventriculo-peritoneal shunt, as well as their impact on the quality of life of patients. The study included 70 patients (age range 1.25 years - 21.25 years) with shunted non-tumor hydrocephalus and at least one year after placement of the shunt system. Hearing alterations were proved by measuring the brainstem auditory evoked potentials (BAEP) for children up to 5 years of age and children with mental retardation; audiograms was used for children older than 5 years with normal neuro-psychological development (NPD). Of the 70 studied patients 17 (24%) had hearing loss (10 bilateral and 7-unilateral) and all of them had sensorineural hearing loss, which is associated with low weight at birth, posthemorrhagic hydrocephalus and brainstem symptoms at the time of diagnosis of hydrocephalus. Hearing pathology was found more often in shunt-treated patients with NPD retardation, poor functional status and low quality of life. Children with shunt-treated hydrocephalus have hearing loss of sensorineural type. Children with brain stem symptomatology at diagnosing hydrocephalus and children with post-hemorrhagic hydrocephalus show higher risk of hearing loss. Children with shunted hydrocephalus and hearing loss show lower NPD, lower quality of life and lower functional status. PMID:27180348

  2. [Recurrent infections in an ITP patient treated with rituximab].

    PubMed

    Rosenberg-Bezalel, Shira; Asher, Ilan; Sthoeger, Zev

    2012-11-01

    Common variable immunodeficiency (CVID) is a heterogeneous group of disorders characterized by hypogammaglobulinemia and recurrent infections. Various mechanisms have been implied in the disease pathophysiology. Patients with CVID are at increased risk of developing ITP (Immune Thrombocytopenia Purpura) and/ or AIHA (Autoimmune Haemolytic Anemia). Rituximab, a humanized anti-CD20 monoclonal antibody, is increasingly being used for autoimmune cytopenias including ITP and AIHA. This is a case history of a patient treated with Rituximab due to refractory ITP. A year after completion of therapy the patient started suffering from an increased frequency of infections. Six years after treatment with Rituximab the patient was diagnosed with CVID and IVIG replacement treatment was started. The main possibilities that this patient presents include aggravation of CVID, first presented as ITP, after Rituximab treatment versus CVID secondary to Rituximab treatment. PMID:23367730

  3. Mitochondrial activity and oxidative stress markers in peripheral blood mononuclear cells of patients with bipolar disorder, schizophrenia, and healthy subjects.

    PubMed

    Gubert, Carolina; Stertz, Laura; Pfaffenseller, Bianca; Panizzutti, Bruna Schilling; Rezin, Gislaine Tezza; Massuda, Raffael; Streck, Emilio Luiz; Gama, Clarissa Severino; Kapczinski, Flávio; Kunz, Maurício

    2013-10-01

    Evidence suggests that mitochondrial dysfunction is involved in the pathophysiology of psychiatric disorders such as schizophrenia (SZ) and bipolar disorder (BD). However, the exact mechanisms underlying this dysfunction are not well understood. Impaired activity of electron transport chain (ETC) complexes has been described in these disorders and may reflect changes in mitochondrial metabolism and oxidative stress markers. The objective of this study was to compare ETC complex activity and protein and lipid oxidation markers in 12 euthymic patients with BD type I, in 18 patients with stable chronic SZ, and in 30 matched healthy volunteers. Activity of complexes I, II, and III was determined by enzyme kinetics of mitochondria isolated from peripheral blood mononuclear cells (PBMCs). Protein oxidation was evaluated using the protein carbonyl content (PCC) method, and lipid peroxidation, the thiobarbituric acid reactive substances (TBARS) assay kit. A significant decrease in complex I activity was observed (p = 0.02), as well as an increase in plasma levels of TBARS (p = 0.00617) in patients with SZ when compared to matched controls. Conversely, no significant differences were found in complex I activity (p = 0.17) or in plasma TBARS levels (p = 0.26) in patients with BD vs. matched controls. Our results suggest that mitochondrial complex I dysfunction and oxidative stress play important roles in the pathophysiology of SZ and may be used in potential novel adjunctive therapy for SZ, focusing primarily on cognitive impairment and disorder progression. PMID:23870796

  4. Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder

    PubMed Central

    Takaesu, Yoshikazu; Inoue, Yuichi; Murakoshi, Akiko; Komada, Yoko; Otsuka, Ayano; Futenma, Kunihiro; Inoue, Takeshi

    2016-01-01

    Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients. PMID:27442503

  5. Prevalence of Circadian Rhythm Sleep-Wake Disorders and Associated Factors in Euthymic Patients with Bipolar Disorder.

    PubMed

    Takaesu, Yoshikazu; Inoue, Yuichi; Murakoshi, Akiko; Komada, Yoko; Otsuka, Ayano; Futenma, Kunihiro; Inoue, Takeshi

    2016-01-01

    Recent studies have suggested that there are certain pathophysiological relationships between bipolar disorder (BD) and circadian rhythm dysfunction. However, apparently no studies have clarified the prevalence of circadian rhythm sleep-wake disorders (CRSWD) in patients with BD. This study was set out to investigate the prevalence of CRSWD and associated factors in patients with BD. One hundred four euthymic BD outpatients participated in this study. The subjects were asked to answer questionnaires including demographic variables, clinical course of BD, and family history of psychiatric disorders and suicide. Severity of BD was assessed by the Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale. CRSWD was diagnosed by clinical interview, together with sleep logs, according to the International Classification of Sleep Disorders, third edition (ICSD-3). Thirty-five subjects (32.4%) met the criteria for CRSWD. The age at the time of investigation and that at the onset of BD were both lower in the CRSWD group than in the non-CRSWD group. The rates of family history of psychiatric disorders and suicide in the CRSWD group were higher than those in the non-CRSWD group. Multiple logistic regression analysis revealed that the presence of CRSWD was significantly associated with younger onset age of BD and family history of suicide. The prevalence of CRSWD could be quite high in BD patients. Younger onset age of BD and family history of suicide were associated with presence of CRSWD in BD patients. PMID:27442503

  6. Psychotherapeutic Treatment of Bipolar Depression.

    PubMed

    McMahon, Kibby; Herr, Nathaniel R; Zerubavel, Noga; Hoertel, Nicolas; Neacsiu, Andrada D

    2016-03-01

    The gold standard for treating bipolar depression is based on the combination of mood stabilizers and psychotherapy. Therefore, the authors present evidence-based models and promising approaches for psychotherapy for bipolar depression. Cognitive-behavioral therapy, family focused therapy, interpersonal and social rhythm therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy are discussed. Behavioral activation, the cognitive behavioral analysis system of psychotherapy, and the unified protocol as promising future directions are presented. This review informs medical providers of the most appropriate referral guidelines for psychotherapy for bipolar depression. The authors conclude with a decision tree delineating optimal referrals to each psychotherapy approach. PMID:26876317

  7. Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features

    PubMed Central

    Ferreira, Berta; Borja-Santos, Nuno; Trancas, Bruno; Monteiro, Céu; Cardoso, Graça

    2016-01-01

    Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state. PMID:26881069

  8. Efficacy of Electroconvulsive Therapy in Bipolar Disorder with Mixed Features.

    PubMed

    Palma, Miguel; Ferreira, Berta; Borja-Santos, Nuno; Trancas, Bruno; Monteiro, Céu; Cardoso, Graça

    2016-01-01

    Introduction. Mixed states represent a frequent presentation of bipolar disorder, associated with higher resistance to psychopharmacology. Limited evidence supports the use of ECT in these patients. We aim to report our experience on treating bipolar mixed states with ECT. Methods. Retrospective data were collected from all bipolar patients submitted to acute ECT treatment, between June 2006 and June 2011. Three groups were created in terms of affective polarity of the episode. CGI rating was used to establish clinical remission and demographic and clinical variables were compared among groups. Long-term outcome was assessed through readmission measures, considering the use of continuation or maintenance ECT. Results. During the study time frame, a total of 50 ECT course treatments were performed on 41 bipolar patients. All affective episodes, except one mixed state, showed a positive clinical response. Patients with mixed state presentation tended to be younger and have an earlier first hospitalization than depressed patients. No differences were found in terms of ECT sessions performed, length of hospital admission, referral to continuation ECT treatment, number of readmissions, and time until next readmission. Conclusions. Our results support the effectiveness of ECT in patients experiencing a mixed affective state. PMID:26881069

  9. Comparison of Sexual Experience and Behavior between Bipolar Outpatients and Outpatients without Mood Disorders

    PubMed Central

    Downey, Jennifer; Friedman, Richard C.; Haase, Elizabeth; Goldenberg, David; Bell, Robinette; Edsall, Sidney

    2016-01-01

    Sexual behavior over the past year of 32 outpatients with Bipolar disorder is compared to that of 44 Comparison patients that had never had an episode of affective illness. Subjects were outpatients treated with drugs and psychotherapy in routine office practice. Differences in sexual behavior between the two groups as a whole were minimal, but meaningful differences emerged when subgroups were compared. Compared to control men, Bipolar men had had more partners in the last year and were more likely to have had sex without condoms. Compared to Bipolar females, Bipolar males had more sex partners, had more sex with strangers, and were more likely to have engaged in homosexual behavior. Even so, some patients in the Comparison group also had engaged in risky sexual behavior. They had failed to use condoms and had had sex with strangers and prostitutes during the previous year. PMID:27190984

  10. Gas emission during laparoscopic colorectal surgery using a bipolar vessel sealing device: A pilot study on four patients

    PubMed Central

    Hübner, Martin; Sigrist, Markus W; Demartines, Nicolas; Gianella, Michele; Clavien, Pierre A; Hahnloser, Dieter

    2008-01-01

    Background Dissection during laparoscopic surgery produces smoke containing potentially toxic substances. The aim of the present study was to analyze smoke samples produced during laparoscopic colon surgery using a bipolar vessel sealing device (LigaSure™). Methods Four consecutive patients undergoing left-sided colectomy were enrolled in this pilot study. Smoke was produced by the use of LigaSure™. Samples (5,5l) were evacuated from the pneumoperitoneum in a closed system into a reservoir. Analysis was performed with CO2-laser-based photoacoustic spectroscopy and confirmed by a Fourier-transform infrared spectrum. The detected spectra were compared to the available spectra of known toxins. Results Samples from four laparoscopic sigmoid resections were analyzed. No relevant differences were noted regarding patient and operation characteristics. The gas samples were stable over time proven by congruent control measurements as late as 24 h after sampling. The absorption spectra differed considerably between the patients. One broad absorption line at 100 ppm indicating H2O and several unknown molecules were detected. With a sensitivity of alpha min ca 10-5 cm-1 no known toxic substances like phenol or indole were identified. Conclusion The use of a vessel sealing device during laparoscopic surgery does not produce known toxic substances in relevant quantity. Further studies are needed to identify unknown molecules and to analyze gas emission under various conditions. PMID:18803818

  11. Treating a transgender patient: overview of the guidelines.

    PubMed

    Wilczynski, Cory; Emanuele, Mary Ann

    2014-11-01

    Transgenderism and gender dysphoria are becoming more prevalent diagnoses and the patient population is increasing. Primary care practitioners, endocrinologists, and mental health professionals are all part of the medical care team that treats these patients, but family and internal medicine physicians continue to deliver the care in the long term. Transgender medicine is not a strong part of the medical curriculum, and recent studies have shown there is anxiety in new physicians in taking care of these patients. There are many aspects to transgender care that involve different specialities, including, but not limited to, mental health, primary care, endocrinology, surgery, and obstetrics and gynecology. This article gives an overview of the current guidelines for standards of care of transgender patients as delineated by the World Professional Association for Transgender Health and the Endocrine Society. PMID:25387220

  12. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor

    PubMed Central

    Parodi, Guido; Storey, Robert F

    2015-01-01

    The occurrence of dyspnoea in acute coronary syndrome (ACS) patients has always been considered a challenging diagnostic and therapeutic clinical scenario. P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) are currently the cornerstone of treatment of ACS patients. Thus, in the last few years, the potential association between ACS and dyspnoea has also become more challenging with the increasing use of ticagrelor in these patients due to its beneficial effects on ischaemic event prevention and mortality, since ticagrelor can induce dyspnoea as a side effect. The present article is intended to review the current literature regarding dyspnoea occurrence in ACS patients, especially those treated with ticagrelor, and to propose ticagrelor-associated dyspnoea management recommendations based on current knowledge. PMID:25267878

  13. Perturbational Profiling of Metabolites in Patient Fibroblasts Implicates α-Aminoadipate as a Potential Biomarker for Bipolar Disorder.

    PubMed

    Huang, Joanne H; Berkovitch, Shaunna S; Iaconelli, Jonathan; Watmuff, Bradley; Park, Hyoungjun; Chattopadhyay, Shrikanta; McPhie, Donna; Öngür, Dost; Cohen, Bruce M; Clish, Clary B; Karmacharya, Rakesh

    2016-07-01

    Many studies suggest the presence of aberrations in cellular metabolism in bipolar disorder. We studied the metabolome in bipolar disorder to gain insight into cellular pathways that may be dysregulated in bipolar disorder and to discover evidence of novel biomarkers. We measured polar and nonpolar metabolites in fibroblasts from subjects with bipolar I disorder and matched healthy control subjects, under normal conditions and with two physiologic perturbations: low-glucose media and exposure to the stress-mediating hormone dexamethasone. Metabolites that were significantly different between bipolar and control subjects showed distinct separation by principal components analysis methods. The most statistically significant findings were observed in the perturbation experiments. The metabolite with the lowest p value in both the low-glucose and dexamethasone experiments was α-aminoadipate, whose intracellular level was consistently lower in bipolar subjects. Our study implicates α-aminoadipate as a possible biomarker in bipolar disorder that manifests under cellular stress. This is an intriguing finding given the known role of α-aminoadipate in the modulation of kynurenic acid in the brain, especially as abnormal kynurenic acid levels have been implicated in bipolar disorder. PMID:27606323

  14. Prognostic factors in recurrent glioblastoma patients treated with bevacizumab.

    PubMed

    Schaub, Christina; Tichy, Julia; Schäfer, Niklas; Franz, Kea; Mack, Frederic; Mittelbronn, Michel; Kebir, Sied; Thiepold, Anna-Luisa; Waha, Andreas; Filmann, Natalie; Banat, Mohammed; Fimmers, Rolf; Steinbach, Joachim P; Herrlinger, Ulrich; Rieger, Johannes; Glas, Martin; Bähr, Oliver

    2016-08-01

    The value of bevacizumab (BEV) in recurrent glioblastoma is unclear. Imaging parameters and progression-free survival (PFS) are problematic endpoints. Few data exist on clinical factors influencing overall survival (OS) in unselected patients with recurrent glioblastoma exposed to BEV. We retrospectively analyzed 174 patients with recurrent glioblastoma treated with BEV at two German brain tumor centers. We evaluated general patient characteristics, MGMT status, pretreatment, concomitant oncologic treatment and overall survival. Karnofsky performance score, number of prior chemotherapies, number of prior recurrences and combined treatment with irinotecan (IRI) were significantly associated with OS in univariate analysis. We did not find differences in OS related to sex, age, histology, MGMT status, prior surgical treatment or number of prior radiotherapies. Combined treatment with IRI and higher KPS both remained significantly associated with prolonged survival in multivariate analysis, but patients receiving IRI co-treatment had less advanced disease. Grouping into clinically relevant categories revealed an OS of 16.9 months from start of BEV in patients with first recurrence and KPS ≥ 80 % (n = 25). In contrast, in patients with second recurrence and KPS < 80 %, OS was 3.6 months (n = 27). Our observational data support an early use of BEV in patients with good performance status. The benefit of co-treatment with IRI in our cohort seems to be the result of biased patient recruitment. PMID:27193554

  15. Bipolar disorder

    PubMed Central

    Goodwin, Frederick K.; Ghaemi, S. Nassir

    1999-01-01

    Bipolar disorder's unique combination of three characteristics - clear genetic diathesis, distinctive clinical features, early availability of an effective treatment (lithium) - explains its special place in the history of psychiatry and its contribution to the current explosive growth of neuroscience. This article looks at the state of the art in bipolar disorder from the vantage point of: (i) genetics (possible linkages on chromosomes 18 and 21q, polygenic hypothesis, research into genetic markers); (ii) diagnosis (new focus on the subjective aspects of bipolar disorder to offset the current trend of underdiagnosis due to overreliance on standardized interviews and rating scales); (iii) outcome (increase in treatment-resistant forms signaling a change in the natural history of bipolar disorder); (iv) pathophysiology (research into circadian biological rhythms and the kindling hypothesis to explain recurrence); (v) treatment (emergence of the anticonvulsants, suggested role of chronic antidepressant treatment in the development of treatment resistance); (vi) neurobiology (evaluation of regulatory function in relation to affective disturbances, role of postsynaptic second-messenger mechanisms, advances in functional neuroimaging); and (vii) psychosocial research (shedding overly dualistic theories of the past to understand the mind and brain as an entity, thus emphasizing the importance of balancing the psychopharmacological and psychotherapeutic approaches). Future progress in the understanding and treatment of bipolar disorder will rely on successful integration of the biological and psychosocial lines of investigation. PMID:22033232

  16. Prognostic factors of hepatocellular carcinoma patients treated by transarterial chemoembolization.

    PubMed

    Xiao, Jun; Li, Guojian; Lin, Shuhan; He, Ke; Lai, Hao; Mo, Xianwei; Chen, Jiansi; Lin, Yuan

    2014-01-01

    We aim to investigate the clinical characteristics and prognostic factors of Hepatocellular Carcinoma (HCC) patients treated by transarterial chemoembolization (TACE) in Chinese cohort. A total of 2,493 HCC patients treated by TACE were included in this retrospective study. Patients were divided into the younger group (n=1,877) or the elderly group (n=616) based upon their ages (cut-off value of 60 y/o). Chi-square test or Wilcoxon rank-sum test was used to compare patients' characteristics. Univariate and multivariate analysis were used to determine prognostic factors. When compared with the younger group, the elderly group had lower male/female ratio and family liver disease history ratio, as well as advanced stage or Child-Pugh grade B patients. The median survival time was 8 months and 27 months for the younger and the elderly group, respectively. The 1-, 2-, and 3-year survival rates in the younger group and the elderly group were 31.82%, 12.5%, 6.53%, and 84.66%, 53.28%, 28.39%, respectively. Multivariate analysis showed that HBV infection, AFP value, TNM stage, Child-Pugh class, portal vein tumor thrombus (PVTT) and tumor number were independent prognostic factors for the younger patients; the elderly ones had similar independent prognostic factors except for HBV infection. The elderly group had lower male/female ratio and family history ratio, as well as advanced stage or Child-Pugh grade B patients. The elderly seems to have better prognosis than the younger ones, which is probably related to the fact that the elderly have lower tumor burden and better liver function. PMID:24696728

  17. Treating Pain in Addicted Patients: Recommendations from an Expert Panel

    PubMed Central

    Cheatle, Martin; Wunsch, Martha; Skoufalos, Alexis; Reddy, Yeshwant

    2014-01-01

    Abstract Clinicians may face pragmatic, ethical, and legal issues when treating addicted patients. Equal pressures exist for clinicians to always address the health care needs of these patients in addition to their addiction. Although controversial, mainly because of the lack of evidence regarding their long-term efficacy, the use of opioids for the treatment of chronic pain management is widespread. Their use for pain management in the addicted population can present even more challenges, especially when evaluating the likelihood of drug-seeking behavior. As the misuse and abuse of opioids continues to burgeon, clinicians must be particularly vigilant when prescribing chronic opioid therapy. The purpose of this article is to summarize recommendations from a recent meeting of experts convened to recommend how primary care physicians should approach treatment of chronic pain for addicted patients when an addiction specialist is not available for a referral. As there is a significant gap in guidelines and recommendations in this specific area of care, this article serves to create a foundation for expanding chronic pain guidelines in the area of treating the addicted population. This summary is designed to be a practical how-to guide for primary care physicians, discussing risk assessment, patient stratification, and recommended therapeutic approaches. (Population Health Management 2014;17:79–89) PMID:24138341

  18. Toxic Epidermal Necrolysis in Polymedicated Patient Treated With Radiotherapy

    PubMed Central

    Pérez-Calderón, Remedios; Corrales-Vargas, Silvia; Jiménez-Ferrera, Gloria; Rodríguez-Nevado, Isabel; Díaz-Delgado, Mario

    2015-01-01

    Temozolomide is an oral alkylating agent indicated for the treatment of patients with glioblastoma multiforme concomitantly with radiotherapy and subsequently as monotherapy treatment. We report the case of a patient who developed toxic epidermal necrolysis (TEN) while she was being treated with chemoradiotherapy and several drugs. Cutaneous tests were performed with the drugs involved with negative result. Although the occurrence of TEN contraindicates suspected drug readministration, we based the decision to perform the controlled administration of temozolomide on the following reasons: (1) the poor prognosis of the underlying disease, (2) the lack of therapeutic alternatives, (3) the suspicion that other drugs taken by the patient simultaneously may be responsible (as anticonvulsants and trimethoprim sulfamethoxazole [TMP-SMX]), and (4) temozolomide was the first choice for treating the patient's disease. The administration of a cumulative dose of 60 mg of temozolomide caused a slight skin reaction. Given this result, we conducted controlled administration of other drugs involved. Dexamethasone, codeine, omeprazole and levetiracetam were well tolerated. However, TMP-SMX produced a similar reaction to that caused by temozolomide. In conclusion, we present the first case of TEN induced by temozolomide and TMP-SMX associated with cranial radiotherapy confirmed by controlled administration. Radiotherapy in combination with these drugs could have favored TEN, as some authors have postulated, but we cannot prove this. PMID:25729629

  19. Maintenance Deep Transcranial Magnetic Stimulation Sessions are Associated with Reduced Depressive Relapses in Patients with Unipolar or Bipolar Depression

    PubMed Central

    Rapinesi, Chiara; Bersani, Francesco Saverio; Kotzalidis, Georgios D.; Imperatori, Claudio; Del Casale, Antonio; Di Pietro, Simone; Ferri, Vittoria R.; Serata, Daniele; Raccah, Ruggero N.; Zangen, Abraham; Angeletti, Gloria; Girardi, Paolo

    2015-01-01

    Introduction: Deep transcranial magnetic stimulation (dTMS) is a new form of TMS allowing safe stimulation of deep brain regions. The objective of this preliminary study was to assess the role of dTMS maintenance sessions in protecting patients with bipolar disorder (BD) or recurrent major depressive disorder (MDD) from developing depressive or manic relapses in a 12-month follow-up period. Methods: Twenty-four drug-resistant patients with a current depressive episode and a diagnosis of MDD or BD have been enrolled in the study. All the participants underwent daily dTMS sessions for 4 weeks. One group (maintenance – M group) received additional maintenance dTMS sessions weekly or twice a week. Results: After the first dTMS cycle, a significant reduction of Hamilton Depression Rating Scale (HDRS) scores was observed in all participants. Subsequently, the HDRS mean scores did not significantly change over time in the M group, while it significantly increased in the non-M-group after 6 and 12 months. Discussion: This study confirms previous evidence of a positive therapeutic effect of dTMS on depressive symptoms and suggests that, after recovery from acute episodes, maintenance dTMS sessions may be helpful in maintaining euthymia in a 12-month follow-up period. PMID:25709596

  20. Training psychiatric staff to treat a multicultural patient population.

    PubMed

    Collins, J L; Mathura, C B; Risher, D L

    1984-04-01

    Cultural and linguistic barriers have long been problems in establishing an effective therapeutic alliance between patients and therapists from different cultural, ethnic, and racial backgrounds. The current emphasis on cultural psychiatry has stimulated the inclusion of culturally relevant material in the curricula of American psychiatric residency programs, such as the program at Howard University Hospital in Washington, D.C. After a preliminary study of foreign patients treated on the psychiatry service, the department of psychiatry established a program of seminars and didactic sessions intended to familiarize staff and trainees with cultural patterns of the largest groups of foreign students attending the university. The department also participated in a transcultural fellowship program for medical students sponsored by the American Psychiatric Association and the National Institute of Mental Health. After describing the programs, the authors briefly discuss such culturally related issues as foreign patients' return to their original language when they develop psychiatric illnesses. PMID:6714949

  1. Insulin-like Growth Factor 1 Differentially Affects Lithium Sensitivity of Lymphoblastoid Cell Lines from Lithium Responder and Non-responder Bipolar Disorder Patients.

    PubMed

    Milanesi, Elena; Hadar, Adva; Maffioletti, Elisabetta; Werner, Haim; Shomron, Noam; Gennarelli, Massimo; Schulze, Thomas G; Costa, Marta; Del Zompo, Maria; Squassina, Alessio; Gurwitz, David

    2015-07-01

    Bipolar disorder (BD) is a chronic psychiatric illness with an unknown etiology. Lithium is considered the cornerstone in the management of BD, though about 50-60 % of patients do not respond sufficiently to chronic treatment. Insulin-like growth factor 1 (IGF1) has been identified as a candidate gene for BD susceptibility, and its low expression has been suggested as a putative biomarker for lithium unresponsiveness. In this study, we examined the in vitro effects of insulin-like growth factor 1 (IGF-1) on lithium sensitivity in lymphoblastoid cell lines (LCLs) from lithium responder (R) and non-responder (NR) bipolar patients. Moreover, we evaluated levels of microRNA let-7c, a small RNA predicted to target IGF1. We found that exogenous IGF-1 added to serum-free media increased lithium sensitivity selectively in LCLs from NR BD patients. However, no significant differences were observed when comparing let-7c expression in LCLs from R vs. NR BD patients. Our data support a key role for IGF-1 in lithium resistance/response in the treatment of bipolar disorder. PMID:25740013

  2. Amisulpride plus valproate vs haloperidol plus valproate in the treatment of acute mania of bipolar I patients: a multicenter, open-label, randomized, comparative trial

    PubMed Central

    Thomas, Pierre; Vieta, Eduard

    2008-01-01

    The primary objective of this study was to compare the effectiveness of combination treatment of valproate and amisulpride with that of valproate and haloperidol in bipolar I disorder. Adult inpatients with a current manic episode fulfilling DSM-IV-TR diagnostic criteria for bipolar type I disorder were included. Patients were randomized to amisulpride (400–800 mg/day) or haloperidol (5–15 mg/day) for 3 months and all received valproate. The primary effectiveness criterion was the percentage of responders (defined by a decrease of ≥50% of the Y-MRS) in patients completing the study. Safety was evaluated by adverse event reporting, determination of extrapyramidal function and clinical examination. Sixty-two patients were randomized to receive valproate-amisulpride, and 61 to receive valproate-haloperidol. At study end, responder rates were 72.6% in the amisulpride group and 65.5% in the haloperidol group. Remission rates were 83.9% and 89.7%, respectively. At study end, neither response rates nor remission rates differed significantly between groups. Treatment-emergent adverse events occurred significantly (p = 0.009) more frequently in the haloperidol group (86.4%) than in the amisulpride group (66.1%). In conclusion, the valproate–amisulpride combination was as effective as the valproate – haloperidol combination in bipolar I patients, with a better safety profile. PMID:18830442

  3. The comparative short-term outcome of bipolar II disorder patients variably meeting or not meeting DSM-5 duration criteria following lamotrigine treatment.

    PubMed

    McCraw, Stacey; Parker, Gordon

    2016-06-01

    There is accruing clinical and empirical evidence supporting the efficacy of lamotrigine as a treatment for bipolar II disorder. However, the treatment response experienced by those with 'short duration' hypomania (or 'other specified' bipolar disorder) has been under-researched. We reviewed a clinical sample of 123 patients diagnosed with a bipolar II disorder three months following their initial assessment. A research interview evaluated treatment strategies implemented, depressive and hypomanic episode pattern and functional outcomes. Of patients who had achieved a minimum level of 75 mg of lamotrigine, n = 51 were assigned to the BP II disorder group (i.e., hypomanic episodes lasted four days or longer) and n = 28 to the short duration group (i.e., hypomanic episodes always lasted less than four days). There were no significant differences between the two groups at the three-month follow-up on self-report measures of changes in depressive and hypomanic episode pattern or functioning across six domains (i.e., intimate relationships, family relationships, friendships, work relationships, work performance, overall quality of life), and with the majority of patients reporting some level of improvement. Study limitations include being an observational, uncontrolled design with a relatively small sample size for detecting statistical differences. Nonetheless, lamotrigine appeared to be a suitable medication to be trialled in patients who alternate between depressive episodes and short periods of hypomania, (as for those with DSM-defined hypomanic episodes), and should prompt further investigation. PMID:26905918

  4. Maintenance Treatment With Varenicline for Smoking Cessation in Patients With Schizophrenia and Bipolar Disorder

    PubMed Central

    Evins, A. Eden; Cather, Corinne; Pratt, Sarah A.; Pachas, Gladys N.; Hoeppner, Susanne S.; Goff, Donald C.; Achtyes, Eric D.; Ayer, David; Schoenfeld, David A.

    2014-01-01

    Importance It is estimated that more than half of those with serious mental illness smoke tobacco regularly. Standard courses of pharmacotherapeutic cessation aids improve short-term abstinence, but most who attain abstinence relapse rapidly after discontinuation of pharmacotherapy. Objective To determine whether smokers diagnosed with schizophrenia and bipolar disease have higher rates of prolonged tobacco abstinence with maintenance pharmacotherapy than with standard treatment. Design, Setting, and Participants Randomized, double-blind, placebo-controlled, parallel-group, relapse-prevention clinical trial conducted in 10 community mental-health centers. Of 247 smokers with schizophrenia or bipolar disease recruited from March 2008-April 2012, 203 received 12-weeks' open-label varenicline and cognitive behavioral therapy and 87 met abstinence criteria to enter the relapse prevention intervention. Interventions Participants who had 2 weeks or more of continuous abstinence at week 12 of open treatment were randomly assigned to receive cognitive behavioral therapy and double-blind varenicline (1 mg, 2 per day) or placebo from weeks 12 to 52. Participants then discontinued study treatment and were followed up to week 76. Main Outcomes and Measures Seven-day rate of continuous abstinence at study week 52, the end of the relapse-prevention phase, confirmed by exhaled carbon monoxide. Secondary outcomes were continuous abstinence rates for weeks 12 through 64 based on biochemically verified abstinence and weeks 12 through 76, based on self-reported smoking behavior. Results Sixty-one participants completed the relapse-prevention phase; 26 discontinued participation (7 varenicline, 19 placebo) and were considered to have relapsed for the analyses; 18 of these had relapsed prior to dropout. At week 52, point-prevalence abstinence rates were 60% in the varenicline group (24 of 40) vs 19% (9 of 47) in the placebo group (odds ratio [OR], 6.2; 95% CI, 2.2-19.2; P < .001). From

  5. Antidepressant chronotherapeutics for bipolar depression.

    PubMed

    Benedetti, Francesco

    2012-12-01

    Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli that act on biological rhythms, in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes manipulations of the sleep-wake cycle such as sleep deprivation and sleep phase advance, and controlled exposure to light and dark. The antidepressant effects of chronotherapeutics are evident in difficult-to-treat conditions such as bipolar depression, which has been associated with extremely low success rates of antidepressant drugs in naturalistic settings and with stable antidepressant response to chronotherapeutics in more than half of the patients. Recent advances in the study of the effects of chronotherapeutics on neurotransmitter systems, and on the biological clock machinery, allow us to pinpoint its mechanism of action and to transform it from a neglected or "orphan" treatment to a powerful clinical instrument in everyday psychiatric practice. PMID:23393416

  6. Antidepressant chronotherapeutics for bipolar depression

    PubMed Central

    Benedetti, Francesco

    2012-01-01

    Chronotherapeutics refers to treatments based on the principles of circadian rhythm organization and sleep physiology, which control the exposure to environmental stimuli that act on biological rhythms, in order to achieve therapeutic effects in the treatment of psychiatric conditions. It includes manipulations of the sleep-wake cycle such as sleep deprivation and sleep phase advance, and controlled exposure to light and dark. The antidepressant effects of chronotherapeutics are evident in difficult-to-treat conditions such as bipolar depression, which has been associated with extremely low success rates of antidepressant drugs in naturalistic settings and with stable antidepressant response to chronotherapeutics in more than half of the patients. Recent advances in the study of the effects of chronotherapeutics on neurotransmitter systems, and on the biological clock machinery, allow us to pinpoint its mechanism of action and to transform it from a neglected or “orphan” treatment to a powerful clinical instrument in everyday psychiatric practice. PMID:23393416

  7. Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges

    PubMed Central

    Epstein, Richard A; Moore, Katherine M; Bobo, William V

    2015-01-01

    Treating pregnant women with bipolar disorder is among the most challenging clinical endeavors. Patients and clinicians are faced with difficult choices at every turn, and no approach is without risk. Stopping effective pharmacotherapy during pregnancy exposes the patient and her baby to potential harms related to bipolar relapses and residual mood symptom-related dysfunction. Continuing effective pharmacotherapy during pregnancy may prevent these occurrences for many; however, some of the most effective pharmacotherapies (such as valproate) have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. Very little is known about the reproductive safety profile and clinical effectiveness of atypical antipsychotic drugs when used to treat bipolar disorder during pregnancy. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated or undertreated maternal bipolar disorder during pregnancy, the effectiveness of interventions for bipolar disorder management during pregnancy, and potential obstetric, fetal, and neonatal risks associated with core foundational pharmacotherapies for bipolar disorder. PMID:25565896

  8. Treatment of bipolar disorders during pregnancy: maternal and fetal safety and challenges.

    PubMed

    Epstein, Richard A; Moore, Katherine M; Bobo, William V

    2015-01-01

    Treating pregnant women with bipolar disorder is among the most challenging clinical endeavors. Patients and clinicians are faced with difficult choices at every turn, and no approach is without risk. Stopping effective pharmacotherapy during pregnancy exposes the patient and her baby to potential harms related to bipolar relapses and residual mood symptom-related dysfunction. Continuing effective pharmacotherapy during pregnancy may prevent these occurrences for many; however, some of the most effective pharmacotherapies (such as valproate) have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. Very little is known about the reproductive safety profile and clinical effectiveness of atypical antipsychotic drugs when used to treat bipolar disorder during pregnancy. In this paper, we provide a clinically focused review of the available information on potential maternal and fetal risks of untreated or undertreated maternal bipolar disorder during pregnancy, the effectiveness of interventions for bipolar disorder management during pregnancy, and potential obstetric, fetal, and neonatal risks associated with core foundational pharmacotherapies for bipolar disorder. PMID:25565896

  9. [Obesity and dyslipidemia in Tunisian bipolar subjects].

    PubMed

    Ezzaher, Asma; Haj Mouhamed, Dhouha; Mechri, Anwar; Neffati, Fadoua; Douki, Wahiba; Gaha, Lotfi; Najjar, Mohamed Fadhel

    2010-01-01

    This study aims to investigate the prevalence of obesity and overweight and their association with lipid parameters in bipolar patients. Our study included 130 patients with bipolar disorder and 130 control subjects aged respectively 37.9 +/- 12.1 and 37.2 +/- 13.1 years. Obesity was evaluated by body mass index (BMI). Concentrations of total cholesterol, triglycerides, cLDL and cHDL were determined by enzymatic methods and ApoA1, ApoB and Lp(a) by techniques immunoturbidimetric. The prevalence of obesity in patients is 30.1% vs 12.3% in controls. A significant increase in BMI was noted in patients compared with controls regardless of sex and tobacco status and in patients aged less than 35 years and those consumers of alcohol. The majority of obese and overweight patients are treated with valproic acid. We found increase in cholesterol (4.41 +/- 1.02 vs 3.90 +/- 0.98 mmol/L), in cLDL (2.13 +/- 1.09 vs 1.29 +/- 0.56 mmol/L) and in Lp(a) (236 +/- 207 vs 163 +/- 150 mg/L) and decrease in HDLc (0.98 +/- 0.28 vs 1.09 +/- 0.36 mmol/L), more frequent at the obese patients and those presenting an overweight. In conclusion, in bipolar patients, obesity and overweight are frequent and associated with perturbations in lipid profile particularly an increase in total cholesterol, cLDL and Lp(a) and decrease in cHDL that increase the risk of cardiovascular disease. PMID:20478770

  10. Reduced mRNA Expression of PTGDS in Peripheral Blood Mononuclear Cells of Rapid-Cycling Bipolar Disorder Patients Compared with Healthy Control Subjects

    PubMed Central

    Peijs, Lone; Kessing, Lars Vedel; Vinberg, Maj

    2015-01-01

    Background: Disturbances related to the arachidonic acid cascade and prostaglandin metabolism may be involved in the pathophysiology of bipolar disorder, as supported by a recent genome-wide association study meta-analysis; however, evidence from clinical studies on a transcriptional level is lacking. Two enzymes in the arachidonic acid cascade are the prostaglandin D synthase (PTGDS), which catalyzes the conversion of prostaglandin H2 to prostaglandin D2 (PGD2), and the aldo-keto reductase family 1 member C3 (AKR1C3), which catalyzes the reduction of PGD2. We aimed to test the hypothesis that mRNA expression of PTGDS and AKR1C3 is deregulated in rapid-cycling disorder patients in a euthymic or current affective state compared with healthy control subjects, and that expression alters with affective states. Methods: PTGDS and AKR1C3 mRNA expression in peripheral blood mononuclear cells was measured in 37 rapid-cycling bipolar disorder patients and 40 age- and gender-matched healthy control subjects using reverse transcription quantitative real-time polymerase chain reaction. Repeated measurements of PTGDS and AKR1C3 mRNA expression were obtained in various affective states during 6–12 months and compared with repeated measurements in healthy control subjects. Results: Adjusted for age and gender, PTGDS mRNA expression was down-regulated in rapid-cycling bipolar disorder patients in a euthymic, depressive, and manic/hypomanic state compared with healthy control subjects. No difference in PTGDS mRNA expression was observed between affective states. AKR1C3 mRNA expression did not differ between bipolar disorder patients in any affective state or in comparison with healthy control subjects. Conclusions: The results suggest a role for aberrantly-regulated PTGDS mRNA expression in rapid-cycling bipolar disorder. The sample size was limited; replication of the findings in larger, independent samples is warranted to further explore the role of the arachidonic acid cascade

  11. Quality of life in patients with ulcerative colitis treated surgically

    PubMed Central

    Kozłowska, Katarzyna A.; Krokowicz, Piotr

    2014-01-01

    Introduction Ulcerative colitis belongs to the group of inflammatory bowel diseases. The specific symptoms and chronic nature of the disease significantly affect the quality of patients’ lives. Quality-of-life assessment helps to define its determining factors as well as the efficiency of surgical procedures. Aim Quality-of-life evaluation of patients with ulcerative colitis treated surgically. Material and methods A retrospective review was carried out on 35 patients with ulcerative colitis, who were treated surgically in the Clinic of General and Colorectal Surgery, University of Medical Sciences in Poznan. The research tools used to assess the quality of life consisted of: the Inflammatory Bowel Disease Questionnaire, a Polish version of the Short Form Health Survey-36, and a questionnaire. Results The mean of the IBDQ scale was 152.51, and the median was 161. In this scale, a higher score indicates better quality of life. The situation in the subjective SF-36 scale is reversed: a lower score indicates better quality of life. The mean of the SF-36 was 115.94, and the median was 58. Many discrepancies in the field (e.g. the influence of determining factors) create a niche for further studies. Conclusions Moreover, quality-of-life evaluation may lead to better patient care, understanding their problems or treatment modifications, and finally may become a kind of therapy efficiency parameter. PMID:25276253

  12. Positional changes of the third molar in orthodontically treated patients

    PubMed Central

    Mihai, AM; Lulache, IR; Grigore, R; Sanabil, AS; Boiangiu, S; Ionescu, E

    2013-01-01

    Objective and Rationale. Over the years, the effects of the third molars eruption on the dental arches have been studied extensively. Still, literature provides less data regarding the effects of the orthodontic treatment on the third molars position. The aim of our study was to assess the positional changes of the third molars relative to the occlusal plane and to the second molar long axis, changes occurred during orthodontic treatment performed with or without premolar extractions. Method. This study included 20 orthodontic treated patients: 10 of them with premolar extractions and 10 without premolar extractions. The pretreatment and post treatment panoramic radiographs were analyzed, and the angles between the third molar long axis and the occlusal plane and between the long axis of the third molar and the long axis of the second molar were measured. Results. Changes in third molar position, from pretreatment to post treatment, for the two groups of patients were evaluated by using the Student’s t-test. The results of the statistical analysis revealed an improvement in third molars position, the best results were seen in the lower third molars, in the group of patients treated with premolar extractions. PMID:23904878

  13. Analysis of polyglutamine-coding repeats in the TATA-binding protein in different human populations and in patients with schizophrenia an bipolar affective disorder

    SciTech Connect

    Rubinsztein, D.C.; Leggo, J.; Crow, T.J.

    1996-09-20

    A new class of disease (including Huntington disease, Kennedy disease, and spinocerebellar ataxias types 1 and 3) results from abnormal expansions of CAG trinucleotides in the coding regions of genes. In all of these diseases the CAG repeats are thought to be translated into polyglutamine tracts. There is accumulating evidence arguing for CAG trinucleotide expansions as one of the causative disease mutations in schizophrenia and bipolar affective disorder. We and others believe that the TATA-binding protein (TBP) is an important candidate to investigate in these diseases as it contains a highly polymorphic stretch of glutamine codons, which are close to the threshold length where the polyglutamine tracts start to be associated with disease. Thus, we examined the lengths of this polyglutamine repeat in normal unrelated East Anglians, South African Blacks, sub-Saharan Africans mainly from Nigeria, and Asian Indians. We also examined 43 bipolar affective disorder patients and 65 schizophrenic patients. The range of polyglutamine tract-lengths that we found in humans was from 26-42 codons. No patients with bipolar affective disorder and schizophrenia had abnormal expansions at this locus. 22 refs., 1 tab.

  14. Opportunistic infections in patients treated with immunotherapy for cancer.

    PubMed

    Kyi, Chrisann; Hellmann, Matthew D; Wolchok, Jedd D; Chapman, Paul B; Postow, Michael A

    2014-01-01

    Immunomodulatory antibodies that enhance the immune system to fight cancer are revolutionizing the treatment of patients with an expanding variety of malignancies. There is a unique spectrum of side effects associated with immunomodulatory antibodies, termed immune-related adverse events (irAEs), which include colitis and hepatitis among others. The treatment of refractory or severe irAEs can occasionally require significant immunosuppression, involving steroids or tumor necrosis factor-alpha antagonists, placing these patients at risk for infections. We present the first reported case to our knowledge of an opportunistic infection in a patient treated with an immunomodulatory antibody. As the use of immunomodulatory antibodies expands and more patients develop irAEs that require treatment with immunosuppression, recognition of the potential for opportunistic infections in this emerging patient population will be critical. Prospective trials are needed to define the optimal immunosuppressive management of irAEs and determine whether prophylactic antiviral, antibacterial, or antifungal therapies are beneficial in this unique population. PMID:24991413

  15. Psychological characteristics of patients treated by chronic maintenance hemodialysis.

    PubMed

    Pop-Jordanova, Nada D; Polenakovic, Momir H

    2013-02-01

    Studies related to psychological aspects of dialysis patients show that depression and anxiety are the most common characteristics. The aim of our study was to analyze the personality profile in patients on chronic maintenance dialysis and to evaluate more specifically the level of depression. The total number of patients was 68 (30 females and 38 males), with mean age 62.3 and 56.5 for females and males respectively. Mean duration of dialysis was 6.73 years for females and 6.68 years for men (the period varied from 0.5 to 18 years). For the evaluation of psychological characteristics, we used two psychometric instruments: Minnesota Multiphase Personality Inventory (MMPI- 201) and Beck Depression Inventory. The obtained results confirmed the presence of depression in patients treated with hemodialysis. The level of depression is variable (minimal is present in 21.43%; mild in 35.71%; moderate in 17.85% and severe in 14.28% of patients). The depression is significantly positively correlated with age (p<0.05) as well as with educational level, and negatively with the duration of dialysis. Specific characteristics of personality obtained with MMPI are hypersensitivity, depressive mood, and withdrawal from friends and relatives. More specific emotional traits are the accentuated anxiety, low level of hostility, but very high passive aggression which destroys their social communications. Some response measures for depression such as relaxation training, psychological support, music therapy, or peripheral biofeedback are recommended. PMID:23335381

  16. Peribulbar anesthesia in 750 patients treated with oral anticoagulants

    PubMed Central

    Calenda, Emile; Genevois, Olivier; Cardon, Annie; Muraine, Marc

    2014-01-01

    AIM To check the safety of continuation of oral anticoagulants in ophthalmic procedures requiring a peribulbar anesthesia. METHOD A prospective case control study included 750 patients with oral anticoagulants in group A and 750 patients who had never been treated with oral anticoagulant in group B. Hemorrhages were graded as follows: 1) spot ecchymosis of eyelid and or subconjunctival hemorrhage; 2) eyelid ecchymosis involving half of the lid surface area; 3) eyelid ecchymosis all around the eye, no increase in intraocular pressure; 4) retrobulbar hemorrhage with increased intraocular pressure. RESULTS In group A, grade 1 was observed in 13 patients (1.74%) and grade 2 in 2 patients (0.26%). In group B, grade 1 was observed in 12 patients (1.6%) and grade 2 was absent. No 3 or 4 hemorrhage grade was encountered in both groups. There was not significant difference in grade 1 hemorrhage between both groups (P=0.21). CONCLUSION Oral anticoagulants were not associated with a significant increase in potentially sight-threatening local anesthetic complications. PMID:24634874

  17. An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia

    PubMed Central

    Kim, Joon Woo; Kim, Yeon Joo; Lee, Yoon Hyung; Kwon, Joon Beom; Cho, Sung Ryong

    2014-01-01

    Purpose In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). Materials and Methods From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. Results ThuVaRP was superior to TURP in catheterization time (p<0.001) and length of hospital stay (p<0.001). However, operation time was longer with ThuVaRP than with TURP (p<0.001). In patients with a large prostate (>50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p<0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. Conclusions The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH. PMID:24466396

  18. Transcriptomic Analysis of Induced Pluripotent Stem Cells Derived from Patients with Bipolar Disorder from an Old Order Amish Pedigree

    PubMed Central

    Kim, Kwi Hye; Liu, Jiangang; Sells Galvin, Rachelle J.; Dage, Jeffrey L.; Egeland, Janice A.; Smith, Rosamund C.; Merchant, Kalpana M.; Paul, Steven M.

    2015-01-01

    Fibroblasts from patients with Type I bipolar disorder (BPD) and their unaffected siblings were obtained from an Old Order Amish pedigree with a high incidence of BPD and reprogrammed to induced pluripotent stem cells (iPSCs). Established iPSCs were subsequently differentiated into neuroprogenitors (NPs) and then to neurons. Transcriptomic microarray analysis was conducted on RNA samples from iPSCs, NPs and neurons matured in culture for either 2 weeks (termed early neurons, E) or 4 weeks (termed late neurons, L). Global RNA profiling indicated that BPD and control iPSCs differentiated into NPs and neurons at a similar rate, enabling studies of differentially expressed genes in neurons from controls and BPD cases. Significant disease-associated differences in gene expression were observed only in L neurons. Specifically, 328 genes were differentially expressed between BPD and control L neurons including GAD1, glutamate decarboxylase 1 (2.5 fold) and SCN4B, the voltage gated type IV sodium channel beta subunit (-14.6 fold). Quantitative RT-PCR confirmed the up-regulation of GAD1 in BPD compared to control L neurons. Gene Ontology, GeneGo and Ingenuity Pathway Analysis of differentially regulated genes in L neurons suggest that alterations in RNA biosynthesis and metabolism, protein trafficking as well as receptor signaling pathways may play an important role in the pathophysiology of BPD. PMID:26554713

  19. Fronto-limbic-striatal dysfunction in pediatric and adult patients with bipolar disorder: impact of face emotion and attentional demands

    PubMed Central

    Brotman, M. A.; Tseng, W.-L.; Olsavsky, A. K.; Fromm, S. J.; Muhrer, E. J.; Rutenberg, J.G.; Deveney, C. M.; Adleman, N. E.; Zarate, C. A.; Pine, D. S.; Leibenluft, E.

    2013-01-01

    Background Research in bipolar disorder (BD) implicates fronto-limbic-striatal dysfunction during face emotion processing but it is unknown how such dysfunction varies by task demands, face emotion and patient age. Method During functional magnetic resonance imaging (fMRI), 181 participants, including 62 BD (36 children and 26 adults) and 119 healthy comparison (HC) subjects (57 children and 62 adults), engaged in constrained and unconstrained processing of emotional (angry, fearful, happy) and non-emotional (neutral) faces. During constrained processing, subjects answered questions focusing their attention on the face; this was processed either implicitly (nose width rating) or explicitly (hostility; subjective fear ratings). Unconstrained processing consisted of passive viewing. Results Pediatric BD rated neutral faces as more hostile than did other groups. In BD patients, family-wise error (FWE)-corrected region of interest (ROI) analyses revealed dysfunction in the amygdala, inferior frontal gyrus (IFG), anterior cingulate cortex (ACC) and putamen. Patients with BD showed amygdala hyperactivation during explicit processing (hostility ratings) of fearful faces and passive viewing of angry and neutral faces but IFG hypoactivation during implicit processing of neutral and happy faces. In the ACC and striatum, the direction of dysfunction varied by task demand: BD demonstrated hyperactivation during unconstrained processing of angry or neutral faces but hypoactivation during constrained processing (implicit or explicit) of angry, neutral or happy faces. Conclusions Findings suggest amygdala hyperactivation in BD while processing negatively valenced and neutral faces, regardless of attentional condition, and BD IFG hypoactivation during implicit processing. In the cognitive control circuit involving the ACC and putamen, BD neural dysfunction was sensitive to task demands. PMID:23930595

  20. A feasibility study of expert patient and community mental health team led bipolar psychoeducation groups: implementing an evidence based practice

    PubMed Central

    2013-01-01

    Background Group psychoeducation is a cost effective intervention which reduces relapse and improves functioning in bipolar disorder but is rarely implemented. The aim of this study was to identify the acceptability and feasibility of a group psychoeducation programme delivered by community mental health teams (CMHTs) and peer specialist (PS) facilitators. Organisational learning was used to identify and address systematically barriers and enablers, at organisational, health professional and patient levels, to its implementation into a routine service. Methods A systematic examination of barriers and enablers to a three day training process informed the delivery of a first treatment group and a similar process informed the delivery of the second treatment group. Triangulation of research methods improved its internal validity: direct observation of training, self-rated surveys of participant experiences, group discussion, and thematically analysed individual participant and facilitator interviews were employed. Results Barriers and enablers were identified at organisational, educational, treatment content, facilitator and patient levels. All barriers under the control of the research team were addressed with subsequent improvements in patient knowledge about the condition and about local service. In addition, self-management, agency and altruism were enhanced. Barriers that could not be addressed required senior clinical and education leadership outside the research team’s control. PS and professional facilitators were successfully trained and worked together to deliver groups which were generally reported as being beneficial. Conclusion Psychoeducation groups involving CMHT and PS facilitators is acceptable and feasible but their sustainment requires senior leadership within and outside the organisation that control finance and education services. PMID:24215655

  1. A technology-enabled adherence enhancement system for people with bipolar disorder: results from a feasibility and patient acceptance analysis

    PubMed Central

    Sajatovic, Martha; Davis, Michael S; Cassidy, Kristin A; Nestor, Joseph; Sams, Johnny; Fuentes-Casiano, Edna

    2015-01-01

    Objective As poor medication adherence is common in bipolar disorder (BD), technology-assisted approaches may help to monitor and enhance adherence. This study evaluated preliminary feasibility, patient satisfaction and effects on adherence, BD knowledge, and BD symptoms associated with the use of a multicomponent technology-assisted adherence enhancement system. Methods This prospective study tested the system in five BD patients over a 15-day period. System components included: 1) an automated pill cap with remote monitoring sensor; 2) a multimedia adherence enhancement program; and 3) a treatment incentive program. This study evaluated system usability, patient satisfaction and effects on adherence (Morisky scale), knowledge (treatment knowledge test [TKT]), and symptoms (internal state scale [ISS]). Results Mean age of the sample was 62 years, 4/5 (80%) Caucasian, and 4/5 (80%) single/divorced or widowed. Most participants (4/5, 80%) were on a single BD medication. Participants had BD for an average of 21 years. Challenges included attaching the pill sensor to standard pharmacy bottles for individuals using very large pill containers or those with multiday pill boxes. Three of five (60%) individuals completed the full 15-day period. Usability scores were high overall. Mean Morisky scores improved. Means on all four subscales of the ISS were all in the direction of improvement. On the TKT, there was a 40% increase in mean scores. Conclusion A multicomponent technology-assisted BD adherence enhancement system is feasible. Challenges include accommodating multiple types of pill containers and monitoring multiple drugs simultaneously. The system can also generate adherence information that is potentially useful for treatment planning. PMID:26089652

  2. [Patient treated with sub-mental intubation for maxillofacial trauma].

    PubMed

    Ricour, C; Ferri, J; Nunes, F; Wiel, E; Raoul, G

    2014-11-01

    Maxillo-facial traumas are frequent and most often occur in young patients. Naso-tracheal or orotracheal intubation may be contraindicated in case of combined occlusal fracture and nasal or ethmoido-nasal fracture. This study was carried out a clinical case of a patient treated at the Lille University Hospital for a maxillofacial trauma associating fracture of nose and maxilla. The purpose was to assess the reliability of submental intubation as an alternative to tracheotomy. Submental intubation is a reliable single and safe technique allowing an one-stage surgical treatment in case of complex association of fractures without using tracheotomy. Its use should be implemented on a larger scale. PMID:25450733

  3. Endophenotypes in bipolar disorder.

    PubMed

    Lenox, Robert H; Gould, Todd D; Manji, Husseini K

    2002-05-01

    The search for genes in bipolar disorder has provided numerous genetic loci that have been linked to susceptibility to developing the disorder. However, because of the genetic heterogeneity inherent in bipolar disorder, additional strategies may need to be employed to fully dissect the genetic underpinnings. One such strategy involves reducing complex behaviors into their component parts (endophenotypes). Abnormal neurophysiological, biochemical, endocrinological, neuroanatomical, cognitive, and neuropsychological findings are characteristics that often accompany psychiatric illness. It is possible that some of these may eventually be useful in subdefining complex genetic disorders, allowing for improvements in diagnostic assessment, genetic linkage studies, and development of animal models. Findings in patients with bipolar disorder that may eventually be useful as endophenotypes include abnormal regulation of circadian rhythms (the sleep/wake cycle, hormonal rhythms, etc.), response to sleep deprivation, P300 event-related potentials, behavioral responses to psychostimulants and other medications, response to cholinergics, increase in white matter hyperintensities (WHIs), and biochemical observations in peripheral mononuclear cells. Targeting circadian rhythm abnormalities may be a particularly useful strategy because circadian cycles appear to be an inherent evolutionarily conserved function in all organisms and have been implicated in the pathophysiology of bipolar disorder. Furthermore, lithium has been shown to regulate circadian cycles in diverse species, including humans, possibly through inhibition of glycogen synthase kinase 3-beta (GSK-3beta), a known target of lithium. PMID:11992561

  4. Rumination in bipolar disorder: evidence for an unquiet mind

    PubMed Central

    2012-01-01

    Depression in bipolar disorder has long been thought to be a state characterized by mental inactivity. However, recent research demonstrates that patients with bipolar disorder engage in rumination, a form of self-focused repetitive cognitive activity, in depressed as well as in manic states. While rumination has long been associated with depressed states in major depressive disorder, the finding that patients with bipolar disorder ruminate in manic states is unique to bipolar disorder and challenges explanations put forward for why people ruminate. We review the research on rumination in bipolar disorder and propose that rumination in bipolar disorder, in both manic and depressed states, reflects executive dysfunction. We also review the neurobiology of bipolar disorder and recent neuroimaging studies of rumination, which is consistent with our hypothesis that the tendency to ruminate reflects executive dysfunction in bipolar disorder. Finally, we relate the neurobiology of rumination to the neurobiology of emotion regulation, which is disrupted in bipolar disorder. PMID:22738363

  5. The Diagnosis and Treatment of Bipolar Disorder: Decision-Making in Primary Care

    PubMed Central

    2014-01-01

    Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis. When treating bipolar patients, the primary care physician has an integral role in coordinating the multidisciplinary network. Pharmacologic treatment underpins both short- and long-term management of bipolar disorder. Maintenance treatment to prevent relapse is frequently founded on the same pharmacologic approaches that were effective in treating the acute symptoms. Regardless of the treatment approach that is selected, monitoring over the long term is essential to ensure continued symptom relief, functioning, safety, adherence, and general medical health. This article describes key decision-making steps in the management of bipolar disorder from the primary care perspective: from initial clinical suspicion to confirmation of the diagnosis to decision-making in acute and longer-term management and the importance of patient monitoring. PMID:25317368

  6. Ovarian tumors in postmenopausal breast cancer patients treated with tamoxifen.

    PubMed

    Cohen, I; Beyth, Y; Tepper, R; Shapira, J; Zalel, Y; Figer, A; Cordoba, M; Yigael, D; Altaras, M M

    1996-01-01

    From September 1, 1989, to November 30, 1994, 175 menopausal breast cancer patients treated with tamoxifen were followed at the authors' institutions. During this period. 16 (9.1%) underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, for various indications. Of these, 10 (62.5%) had either uni- or bilateral ovarian tumors. The analysis of surgical findings showed an incidence of 5.7% (10/175) ovarian tumors among all the patients. In 2 (20%), the ovarian masses displayed enlargement over a relatively short period while on treatment. In 5 (50%) patients, the findings were bilateral. All tumors were detectable by ultrasonography, except four serous cystadenomas found in 3 women. The mean duration of tamoxifen treatment was 36.6 +/- 24.9 (range 9-86) months. The rate of 5.7% for ovarian tumors, in this selected group of patients, is four to five times higher than that reported for similar pathologic conditions detected by general screening with ultrasonographic scans among nonselected, asymptomatic, and untreated postmenopausal women. Two possibilities should be considered in the development of ovarian tumors coinciding with tamoxifen treatment; (1) women with breast malignancy are prone to develop benign or malignant ovarian tumors in relation to genetic factors, regardless of tamoxifen treatment; and (2) tamoxifen may stimulate enlargement of such tumors and may even cause them. PMID:8557228

  7. Strategies for treating compensatory articulation in patients with cleft palate.

    PubMed

    Del Carmen Pamplona, Maria; Ysunza, Antonio; Morales, Santiago

    2014-03-01

    Patients with cleft palate frequently show compensatory articulation (CA). CA requires a prolonged period of speech intervention. Some scaffolding strategies can be useful for correcting placement and manner of articulation in these cases. The purpose of this paper was to study whether the use of specific strategies of speech pathology can be more effective if applied according to the level of severity of CA. Ninety patients with CA were studied in two groups. One group was treated using strategies specific for their level of severity of articulation, whereas in the other group all strategies were used indistinctively. The degree of severity of CA was compared at the end of the speech intervention. After the speech therapy intervention, the group of patients in which the strategies were used selectively, showed a significantly greater decrease in the severity of CA, as compared with the patients in whom all the strategies were used indistinctively. An assessment of the severity of CA can be useful for selecting the strategies, which can be more effective for correcting the compensatory errors. PMID:24711749

  8. Retrospective Study of Japanese Patients with Schizophrenia Treated with Aripiprazole

    PubMed Central

    Tanioka, Tetsuya; Fuji, Syoko; Kataoka, Mika; King, Beth; Tomotake, Masahito; Yasuhara, Yuko; Locsin, Rozzano; Sekido, Keiko; Mifune, Kazushi

    2012-01-01

    Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (P = 0.04), significant decrease in dosage of antipsychotics in 71% of patients (P = 0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (P = 0.07) and body mass index (BMI) (P = 0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (P = 0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL. PMID:22970386

  9. Possible Addiction Transference From Cocaine Insufflation to Oral Bupropion in Bipolar Patient

    PubMed Central

    Araujo, Alberto; Brasil, Marco; Cruz, Marcelo

    2015-01-01

    Objective: Alert for the risk of oral bupropion addiction in patients with cocaine dependence. Methods: Single-case study. Results: After a period of cocaine and alcohol abstinence, a 42-year-old patient started taking oral bupropion to relieve the symptoms of cocaine craving. He increased the bupropion dose up to 2250 mg/d without seizures. Conclusion: This case highlights the possibility of oral bupropion addiction after cocaine dependence. To our knowledge, it is the first case in the literature and emphasizes the risk of bupropion's misuse. Therefore, physicians should carefully examine the patient's profile before prescribing it, as well as follow appropriate measures. PMID:25494008

  10. Malignancy rates in patients with rheumatoid arthritis treated with tocilizumab

    PubMed Central

    Rubbert-Roth, Andrea; Sebba, Anthony; Brockwell, Laura; Kelman, Ariella; Porter-Brown, Benjamin; Pulley, Jennifer; Napalkov, Pavel; van Vollenhoven, Ronald F

    2016-01-01

    Objective To analyse malignancy rates in patients with rheumatoid arthritis (RA) treated with tocilizumab. Methods Patients who received tocilizumab or placebo+methotrexate/disease-modifying antirheumatic drugs in the double-blind phases of 5-phase three trials or who received at least 1 dose of tocilizumab in the long-term extension studies were analysed up to the 2 May 2012 cut-off date. Malignancies were monitored throughout the studies, analysed and adjudicated as malignant by medical review. Risk was compared with that in the general population using standardised incidence ratios (SIRs) based on data from the Surveillance Epidemiology and End Results SEER (US general population) and GLOBOCAN (non-US general population) databases. Results In total, 4009 patients in the tocilizumab all-exposure population were included. Mean treatment duration was 4.0 years (mean 5.1 (range 0.0–6.8); total observation time was 16 120.1 patient-years (PY). The adjudicated malignancy rate (95% CI) was 1.26/100 PY (1.09 to 1.44) and remained constant over time. The SIR (95% CI) for all malignancies combined, excluding non-melanoma skin cancer, was 1.36 (1.01 to 1.80) for US and 1.81 (1.44 to 2.23) for non-US populations, driven primarily by higher rates in lung and bronchus (US/non-US) malignancies and prostate cancer and non-Hodgkin lymphoma (non-US), in contrast to those for the general populations; these higher rates are in line with those expected in patients with RA or in the geographic regions studied. Conclusions Malignancy rates remained stable with long-term tocilizumab treatment, and malignancy types and rates were consistent with those expected in patients with RA. PMID:27252893

  11. Hyperuricemia and uncontrolled hypertension in treated hypertensive patients

    PubMed Central

    Cho, Jaelim; Kim, Changsoo; Kang, Dae Ryong; Park, Jeong Bae

    2016-01-01

    Abstract Previous epidemiological studies have suggested that uric acid is an independent risk factor for incident hypertension, whereas few studies have evaluated the effect of hyperuricemia on blood pressure control in hypertensive patients. We investigated whether hyperuricemia predicts uncontrolled hypertension through a large-scale prospective cohort study with hypertensive patients treated with fimasartan in the Republic of Korea (the Kanarb–Metabolic Syndrome study). Of the 10,601 hypertensive patients who were recruited from 582 private clinics and 11 university hospitals at baseline, 7725 completed the follow-up after 3 months of fimasartan medication, and 6506 were included in the analysis after excluding those with missing values. We estimated the risk of uncontrolled hypertension after 3 months (≥130/80 mm Hg in those with diabetes or chronic renal failure and ≥140/90 mm Hg in the remaining patients) related with baseline hyperuricemia (serum uric acid ≥7 mg/dL in males ≥6 mg/dL in females) using multiple logistic regression models. Hyperuricemia increased the risk of uncontrolled hypertension after 3 months of fimasartan medication (odds ratio, 1.247; 95% confidence interval, 1.063–1.462). Males in the highest quartile of uric acid level were at a 1.322 (95% confidence interval, 1.053–1.660) times higher risk of uncontrolled hypertension in reference to the lowest quartile; the same analyses in females were not significant. Patients without metabolic syndrome had significantly higher odds of uncontrolled hypertension with hyperuricemia (odds ratio, 1.328; 95% confidence interval, 1.007–1.751). Hyperuricemia predicted uncontrolled hypertension even after 3 months of fimasartan treatment in hypertensive patients. PMID:27428212

  12. Do Comorbid Anxiety Disorders Moderate the Effects of Psychotherapy for Bipolar Disorder? Results From STEP-BD

    PubMed Central

    Deckersbach, Thilo; Peters, Amy T.; Sylvia, Louisa; Urdahl, Anna; Magalhães, Pedro V.S.; Otto, Michael W.; Frank, Ellen; Miklowitz, David J.; Berk, Michael; Kinrys, Gustavo; Nierenberg, Andrew

    2013-01-01

    Objective At least 50% of individuals with bipolar disorder have a lifetime anxiety disorder. Individuals with both bipolar disorder and a co-occurring anxiety disorder experience longer illness duration, greater illness severity, and poorer treatment response. The study explored whether comorbid lifetime anxiety in bipolar patients moderates psychotherapy treatment outcome. Method In the Systematic Treatment Enhancement Program randomized controlled trial of psychotherapy for bipolar depression, participants received up to 30 sessions of intensive psychotherapy (family-focused therapy, interpersonal and social rhythm therapy, or cognitive-behavioral therapy) or collaborative care, a three-session comparison treatment, plus pharmacotherapy. Using the number needed to treat, we computed effect sizes to analyze the relationship between lifetime anxiety disorders and rates of recovery across treatment groups after 1 year. Results A total of 269 patients (113 women) with a comorbid lifetime anxiety disorder (N=177) or without a comorbid lifetime anxiety disorder (N=92) were included in the analysis. Participants with a lifetime anxiety disorder were more likely to recover with psychotherapy than with collaborative care (66% compared with 49% recovered over 1 year; number needed to treat=5.88, small to medium effect). For patients without a lifetime anxiety disorder, there was no difference between rates of recovery in psychotherapy compared with collaborative care (64% compared with 62% recovered; number needed to treat=50, small effect). Participants with one lifetime anxiety disorder were likely to benefit from intensive psychotherapy compared with collaborative care (84% compared with 53% recovered; number needed to treat=3.22, medium to large effect), whereas patients with multiple anxiety disorders exhibited no difference in response to the two treatments (54% compared with 46% recovered; number needed to treat=12.5, small effect). Conclusions Depressed patients

  13. Modern approach to treating mental patients in colonial chosun.

    PubMed

    Lee, Bang Hyun

    2013-08-01

    them or who posed a threat to others, or else commissioned them to the government hospital. Thus, the final responsibility for mental patients was imposed on the modern Western medical team, because the district commissioners sent them to the police and the police sent them to the government mental hospital. Most educated people and government personnel in the colonial era thought modern Western psychiatry circles were responsible for mental patient management, and the Japanese empire enacted mental-healthrelated laws and made efforts to secure funds for the establishment of mental hospitals. As the literature at that time also show the position of the modern Western medical circle, their ambivalent attitude to mental patients must also be clarified to interpret the modern approach to treating mental patients in colonial Chosun. In this context, a research on historical figures in Japanese psychiatry, a study on the specific treatment methods used by the modern Western psychiatric team in the colonial era and their effects, and the extension of the subject period for such researches are suggested. PMID:24005649

  14. Symptom severity, self-reported adherence, and electronic pill monitoring in poorly adherent patients with bipolar disorder

    PubMed Central

    Sajatovic, Martha; Levin, Jennifer; Sams, Johnny; Cassidy, Kristin A; Akagi, Kouri; Aebi, Michelle E; Ramirez, Luis F; Safren, Steven A; Tatsuoka, Curtis

    2015-01-01

    Objectives This analysis of screening and baseline data from an ongoing trial examined self-report versus automated adherence monitoring and assessed the relationship between bipolar disorder (BD) symptoms and adherence in 104 poorly adherent individuals. Methods Adherence was measured with the Tablets Routine Questionnaire (TRQ) and the Medication Event Monitoring System (MEMS). Symptoms were measured with the Montgomery–Åsberg Depression Rating Scale (MADRS), the Young Mania Rating Scale (YMRS), and the Brief Psychiatric Rating Scale (BPRS). Results Mean age of the sample was 46.3 years [standard deviation (SD) = 9.41], with 72% (n = 75) women and 71% (n = 74) African American subjects. Adherence improved from screening to baseline with a mean missed drug proportion measured by TRQ of 61.43% (SD = 26.48) versus baseline mean of 46.61% (SD = 30.55). Mean proportion of missed medication using MEMS at baseline was 66.43% (SD = 30.40). Correlation between TRQ and MEMS was 0.47. Correlation between a single index drug and all BD medications was 0.95. Symptoms were generally positively correlated with TRQ (worse adherence = more severe symptoms), but in most instances was only at a trend level (p > 0.05) with the exception of correlation between baseline TRQ and MADRS and BPRS, which were positive (r = 0.20 and r = 0.21, respectively) and significant (p ≤ 0.05). Conclusions In patients with BD, monitoring increased adherence by 15%. MEMS identified 20% more non-adherence than self-report. Using a standard procedure to identify a single index drug for adherence monitoring may be one way to assess global adherence in patients with BD receiving polypharmacy treatment. Greater BD symptom severity may be a clinical indicator to assess for adherence problems. PMID:26529124

  15. Bipolar electrochemistry.

    PubMed

    Fosdick, Stephen E; Knust, Kyle N; Scida, Karen; Crooks, Richard M

    2013-09-27

    A bipolar electrode (BPE) is an electrically conductive material that promotes electrochemical reactions at its extremities (poles) even in the absence of a direct ohmic contact. More specifically, when sufficient voltage is applied to an electrolyte solution in which a BPE is immersed, the potential difference between the BPE and the solution drives oxidation and reduction reactions. Because no direct electrical connection is required to activate redox reactions, large arrays of electrodes can be controlled with just a single DC power supply or even a battery. The wireless aspect of BPEs also makes it possible to electrosynthesize and screen novel materials for a wide variety of applications. Finally, bipolar electrochemistry enables mobile electrodes, dubbed microswimmers, that are able to move freely in solution. PMID:23843205

  16. Cabergoline can induce mania with psychotic features in bipolar I disorder: a case report.

    PubMed

    Rovera, Chiara; Cremaschi, Laura; Thanju, Amod; Fiorentini, Alessio; Mauri, Massimo Carlo; Serati, Marta; Lindenmayer, Jean Pierre; Altamura, A Carlo

    2016-08-01

    Up to date, only a small evidence of psychosis induced by cabergoline is available in literature. Herein, the case of a 34-year-old bipolar patient treated with cabergoline has been described. Cabergoline is generally a safe and effective method of reducing prolactin levels and it may be associated with psychiatric side effects, including psychotic features. PMID:27520906

  17. Activation of kynurenine pathway in ex vivo fibroblasts from patients with bipolar disorder or schizophrenia: cytokine challenge increases production of 3-hydroxykynurenine.

    PubMed

    Johansson, Anne-Sofie; Owe-Larsson, Björn; Asp, Linnéa; Kocki, Tomasz; Adler, Mats; Hetta, Jerker; Gardner, Renee; Lundkvist, Gabriella B S; Urbanska, Ewa M; Karlsson, Håkan

    2013-11-01

    Accumulating data suggest a causative link between immune stimulation, disturbed metabolism of tryptophan, and pathogenesis of bipolar disorder and schizophrenia. The goal of this study was to examine the production of kynurenic acid (KYNA), 3-hydroxykynurenine (3-HK) and the expression of kynurenine pathway enzymes involved in their synthesis and metabolism in cultured skin fibroblasts obtained from patients with bipolar disorder, schizophrenia or from healthy control individuals. The assessment was performed under basal conditions or following treatment with interferon (IFN)-γ, tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, or their combinations, in cells exposed to exogenous kynurenine. In both groups of patients, the baseline production of KYNA and 3-HK was increased, as compared to control subjects. Case-treatment analyses revealed significant interactions between bipolar case status and IL-1β, IL-6, IFN-γ + TNF-α, or IFN-γ + IL-1β, as well as between schizophrenia case status and IL-1β, IFN-γ + TNF-α, or IFN-γ + IL-1β, in terms of higher 3-HK. Noteworthy, no case-treatment interactions in terms of KYNA production were found. Observed changes did not appear to correlate with the expression of genes encoding kynurenine aminotransferases (KATs), kynureninase (KYNU) or kynurenine-3-monooxygenase (KMO). The single nucleotide polymorphisms (SNPs), rs1053230 and rs2275163, in KMO influenced KYNA levels yet did not explain the case-treatment discrepancies. In conclusion, our present findings indicate the utility of skin-derived fibroblasts for kynurenines research and support the concept of kynurenine pathway alterations in bipolar disorder and schizophrenia. The increase in ratio between neurotoxic 3-HK and neuroinhibitory/neuroprotective KYNA following exposure to cytokines may account for altered neurogenesis and structural abnormalities characteristic for both diseases. PMID:24012176

  18. Types of Bipolar Disorder

    MedlinePlus

    ... Research Studies Peer Support Research WeSearchTogether Types of Bipolar Disorder There are several kinds of bipolar disorder. Each ... like an illness. What is the difference between bipolar disorder and ordinary mood swings? The three main things ...

  19. Bipolar-Battery Construction

    NASA Technical Reports Server (NTRS)

    Rippel, Wally E.; Edwards, Dean B.

    1988-01-01

    Bipolar batteries fabricated in continuous quasi-automated process. Components of battery configured so processing steps run sequentially. Key components of battery, bipolar plate and bipolar separator, fabricated separately and later joined together.

  20. Update in mortality in GH-treated patients.

    PubMed

    Erfurth, Eva Marie

    2013-11-01

    During GH therapy for 2.3-9.6 years, male adult-onset GH-deficient patients with a diagnosis of a nonfunctioning adenoma have no increased all-cause mortality. However, women with adult-onset GH deficiency (GHD) are still at slightly higher risk. This general improvement in mortality is due to a more contemporary regimen of cardiovascular drugs, a refinement of surgical procedures, besides the introduction of GH therapy improved hormone replacement regimens with lowered glucocorticoid replacement, updated approaches of sex steroids for women, and less use of cranial radiotherapy. The underlying disease is the most important predictor for mortality: eg, a craniopharyngioma, malignant causes of hypopituitarism, previous Cushing's disease, and the presence of diabetes insipidus/aggressive tumors. The main cause of increased mortality was cerebrovascular diseases and infectious/respiratory diseases in ACTH-deficient patients. Furthermore, there was a significant impact of young age at disease onset and of death from secondary brain tumors, with a higher risk after cranial radiotherapy. Reports on four cohorts of GH-treated childhood-onset GHD patients have been published. Two of them included only patients with idiopathic isolated GHD, neurosecretory dysfunction, idiopathic short stature, or being born short for gestational age. Increased mortality in circulatory disorders, ill-defined diseases, and bone cancer were recorded in one study, but not in the other smaller study, where suicide and accidents caused the majority of deaths. A third childhood-onset GHD cohort included patients with a background of malignant tumors, craniopharyngioma, pituitary adenomas, pituitary aplasia/hypoplasia, and trauma. An increase of all-cause mortality was recorded in both males and females. The fourth cohort included isolated GHD and idiopathic short stature (60%), but also diagnosis of chronic renal failure and Turner's syndrome. In these latter studies, an underlying serious

  1. Risk groups in bladder cancer patients treated with radical cystectomy

    PubMed Central

    Mallen, Eva; Gil, Pedro; Gil, Maria Jesus

    2015-01-01

    Objective To stratify patients with bladder cancer into homogeneous risk groups according to statistically significant differences found in PFS (progression-free survival). To identify those patients at increased risk of progression and to provide oncological follow-up according to patient risk group. Materials and Methods A retrospective study of 563 patients treated with radical cystectomy (RC). In order to determine which factors might predict bladder tumour progression and death, uni- and multivariate analyses were performed. The risk groups were identified according to “inter-category” differences found in PFS and lack of differences, thus revealing intra-category homogeneity. Results Median follow up time was 37.8 months. Recurrence occurred in a total of 219 patients (38, 9%). In 63% of cases this was distant recurrence. Only two variables retained independent prognostic value in the multivariate analysis for PFS: pathological organ confinement and lymph node involvement. By combining these two variables, we created a new “risk group” variable. In this second model it was found that the new variable behaved as an independent predictor associated with PFS. Four risk groups were identified: very low, low, intermediate and high risk: • Very low risk: pT0 N0 • Low risk: pTa, pTis, pT1, pT2 and pN0 • Intermediate risk: pT3 and pN0 • High risk: pT4 N0 or pN1-3. Conclusions We retrospectively identified 4 risk groups with an independent prognostic value for progression-free survival following RC. Differences in recurrence patterns after RC between risk groups have led us to set different intervals in monitoring for cancer. PMID:25928508

  2. Deformity incidence in leprosy patients treated with multidrug therapy.

    PubMed

    Rao, P S; Subramanian, M; Subramanian, G

    1994-01-01

    The records of 2,285 (2,007 paucibacillary (PB) and 278 multibacillary (MB)) cases of leprosy which were declared as released from treatment (RFT) after multidrug therapy (MDT) and under surveillance as per the National Leprosy Eradication Programme (NLEP) guidelines in the rural field practice area of Central Leprosy Teaching & Research Institute (CLTRI), Chengalpattu, between September 1986 and September 1993 were analyzed for collecting data on the incidence of deformity. Of the 2,285 cases 2,053 (1,947 PB and 106 MB) did not have deformity at the commencement of treatment. Three MB cases and one PB case out of the 2,053 developed deformity (all grade II) during the course of treatment. No patient developed deformity during surveillance. Thus the deformity incidence in the population of patients was 0.681 per 1000 person-years of observation. Age, sex, type of disease, prior dapsone monotherapy and nerve involvement at the commencement of treatment appear to influence the deformity incidence. The risk of development of deformity in patients treated with MDT appear to be very low and analysis of larger data sets is suggested to corroborate the above findings as the information would be useful for planning prevention and management of deformity services. PMID:7714354

  3. Comparative Study of Heart Rate Variability in Patients with Schizophrenia, Bipolar Disorder, Post-traumatic Stress Disorder, or Major Depressive Disorder

    PubMed Central

    Moon, Eunok; Kim, Do-Hyung; Hwang, Boram

    2013-01-01

    Objective Heart rate variability (HRV) changes as a function of psychiatric illness. This study aimed to evaluate HRV among patients with various psychiatric disorders. Methods The present study recruited patients with schizophrenia (n=35), bipolar disorder (n=41), post-traumatic stress disorder (PTSD; n=34), or major depressive disorder (n=34) as well as healthy controls (n=27). The time-domain analysis (the standard deviation of all RR intervals [SDNN] and the square root of the mean squared differences of successive normal sinus intervals [RMSSD]), the frequency-domain analysis (very low frequency, low frequency [LF], high frequency [HF], and total power [TP]), and a non-linear complexity measure the approximate entropy were computed. Results SDNN and HF were significantly reduced in patients with schizophrenia compared with healthy controls. SDNN, RMSSD, TP, LF, and HF were significantly reduced in bipolar patients compared with healthy controls. HF was significantly reduced in PTSD patients compared with healthy controls. Conclusion Our findings indicate that HRV is not sufficiently powerful to discriminate among various psychiatric illnesses. However, our results suggest that HRV, particularly HF, could be used as a tool for discriminating between psychiatric patients and healthy controls. PMID:24465250

  4. Scurvy in an alcoholic patient treated with intravenous vitamins.

    PubMed

    Ong, John; Randhawa, Rabinder

    2014-01-01

    Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2-3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment. PMID:24728889

  5. Neuropsychiatric sequelae in an efavirenz treated patient with hepatitis B

    PubMed Central

    Salter, Emma; Patel, Anish S

    2009-01-01

    We report the case of a 34-year-old man of African origin, positive for both HIV and hepatitis B virus, who developed symptoms of mania and psychosis while being treated with efavirenz (a non-nucleoside reverse transcriptase inhibitor used in HIV therapy) that required inpatient psychiatric admission and treatment with antipsychotic medication. Our case illustrates multiple predisposing and precipitating factors occurring simultaneously that have been previously implicated individually in the development of neuropsychiatric complications with efavirenz (and other HIV treatments in general). We suggest that patient’s commenced on antiretroviral medication should have a screening process for pre-existing mental and medical health problems as well as psychosocial risk factors that might put a patient at risk. In addition with advances in pharmacogenomics we advocate future cytochrome P450 gene variant testing coupled with routine efavirenz plasma concentration monitoring to help ensure maximum treatment benefit and minimal risk of side effects. PMID:22121393

  6. Scurvy in an alcoholic patient treated with intravenous vitamins

    PubMed Central

    Ong, John; Randhawa, Rabinder

    2014-01-01

    Vitamin C deficiency is rare in developed countries but there is an increased prevalence in chronic alcohol abusers. In the UK, it is common practice to treat patients with chronic alcoholism who are admitted to hospital with intravenous vitamins B1, B2, B3, B6 and C for 2–3 days, followed by oral thiamine and vitamin B-compound tablets. This is a case of a 57-year-old man with a history of chronic alcoholism and chronic obstructive lung disease who was admitted to the intensive care unit for pneumonia requiring ventilatory support. He was given high doses of intravenous vitamins B1, B2, B3, B6 and C for 3 days then oral thiamine and vitamin B compound tablets but developed scurvy 4 days later. He was restarted on oral vitamin C supplementation and showed signs of improvement within 3 days of treatment. PMID:24728889

  7. Diagnosis and treatment of postpartum bipolar depression.

    PubMed

    Kelly, Erin; Sharma, Verinder

    2010-07-01

    The postpartum period is a time of increased risk of new-onset psychiatric illness, hospital admissions and out-patient psychiatric care for new mothers. Research into postpartum mood disorders has focused primarily on major depressive disorder, and has overlooked the study of bipolar disorder, particularly bipolar II disorder and bipolar disorder not otherwise specified. Failure to properly diagnose postpartum bipolar disorder may delay the initiation of appropriate treatment, lead to inappropriate treatment - thereby precipitating (hypo)mania, rapid cycling or a mixed episode - or result in polypharmacy and treatment refractoriness. The most serious consequence, however, is the high risk of infanticide and suicide among women with postpartum bipolar disorder. While no specific screening tools have been validated for postpartum mania or bipolar depression, symptoms of hypomania, atypical depression, a family history of bipolar disorder and a rapid onset of depressive symptoms following delivery may suggest a bipolar diathesis. In the absence of any pharmacological or psychotherapeutic treatments to guide clinical decision-making, it is recommended that the treatment of postpartum bipolar depression follow the same guidelines as the treatment of non-postpartum bipolar depression, using medications that are compatible with lactation. PMID:20586688

  8. A case of lithium intoxication induced by an antihypertensive angiotensin 1 subtype-specific angiotensin II receptor blocker in an elderly patient with bipolar disorder and hypertension.

    PubMed

    Hayashi, Yuichi; Nishida, Shohei; Takekoshi, Akira; Murakami, Muneharu; Yamada, Megumi; Kimura, Akio; Suzuki, Akio; Inuzuka, Takashi

    2016-01-01

    Lithium carbonate is considered to be a first-line treatment for bipolar disorder; however, this drug has a narrow therapeutic window, and lithium intoxication is commonly induced by various drugs interaction and situations. We herein report a case of lithium intoxication induced by the administration of an antihypertensive agent targeting the angiotensin 1 (AT1) subtype of the angiotensin II receptor in a 65-year-old woman with a 40-year history of bipolar disorder type 1, and 1-year history of essential hypertension. Her bipolar disorder had been well-controlled with 600 mg/day of lithium carbonate for more than 10 years. She was later diagnosed with hypertension and the AT1 receptor blocker, azilsartan was thereafter administrated on a daily basis. After 3 weeks of azilsartan administration, she presented with progressive action tremor and showed a gradual deterioration of her physical state. Four months after the start of azilsartan administration, she presented with alternating episodes of diarrhea and constipation. Two weeks before admission to our hospital, she presented with mild consciousness disturbances, myoclonus, truncal ataxia, and appetite loss. She was diagnosed to have lithium intoxication based on an elevated serum lithium concentration of 3.28 mEq/l.It is therefore important to evaluate the serum lithium concentration after the administration of antihypertensive agents, and consider lithium-antihypertensive agent interactions when selecting antihypertensive agents in elderly patients receiving long-term lithium carbonate treatment. PMID:27535187

  9. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations.

    PubMed

    Frye, Mark A; Salloum, Ihsan M

    2006-12-01

    Classic Kraepelian observations and contemporary epidemiological studies have noted a high prevalence rate between bipolar disorder and alcoholism. The extent to which these two illnesses are comorbid (i.e., two distinct disease processes each with an independent course of illness), genetically linked, or different phenotypic expressions of bipolar illness itself continues to be investigated. It is increasingly clear that co-occurring alcohol abuse or dependence in bipolar disorder phenomenologically changes the illness presentation with higher rates of mixed or dysphoric mania, rapid cycling, increased symptom severity, and higher levels of novelty seeking, suicidality, aggressivity, and impulsivity. It is very encouraging that interest and efforts at evaluating pharmacotherapeutic compounds has substantially increased over the past few years in this difficult-to-treat patient population. This article will review the clinical studies that have evaluated the effectiveness of conventional mood stabilizers (lithium, carbamazepine, divalproex, and atypical antipsychotics) in the treatment of alcohol withdrawal and relapse prevention in patients with alcoholism and in the treatment of bipolar disorder with comorbid alcoholism. A number of add-on, adjunctive medications, such as naltrexone, acamprosate, topiramate, and the atypical antipsychotics quetiapine and clozapine, may be candidates for further testing. PMID:17156154

  10. Cognitive deficits in first-degree relatives of bipolar patients: the use of homogeneous subgroups in the search of cognitive endophenotypes.

    PubMed

    Volkert, Julia; Haubner, J; Kazmaier, J; Glaser, F; Kopf, J; Kittel-Schneider, S; Reif, A

    2016-08-01

    Previous studies have demonstrated impairments in attention, memory and executive functions in euthymic bipolar patients (BP) as well as their unaffected first-degree relatives, albeit in an attenuated form. Subsequently, cognitive deficits are discussed as a possible endophenotype of bipolar disorder. However, recent studies showed that only a subgroup of BP shows cognitive impairments. The aim of the present study was to investigate cognitive functioning in relatives compared to BP, to find out if the differentiation in a cognitive deficit vs. non-deficit subgroup is valid for relatives of BP, too. Therefore, the performance of 27 unaffected relatives of BP, 27 euthymic BP and 27 HC were compared using a neuropsychological test battery. The results showed that BP exhibited a reduced psychomotor speed and deficits in working memory compared to relatives and HC. Relatives performed significantly slower (psychomotor speed) as compared to HC (p = 0.024); performance in the other test measures lie between BP and HC. Furthermore, a detailed evaluation of the data indicated that only subgroups of BP and relatives exhibited cognitive impairments in the implemented tests. However, the deficit and non-deficit groups did not differ in sociodemographic and clinical variables from each other, possibly due to the small sample size. In conclusion, our results suggest that reduced psychomotor speed could serve as a potential endophenotype for bipolar disorder which should be investigated along the developmental trajectory of this disorder, also to examine whether abnormalities therein precede onset of the first mood episode. Furthermore, the division of relatives into subgroups aids in the identification of stable trait markers and high-risk bipolar groups and could enable early prevention strategies. As to that more research using distinct and homogeneous subgroups is necessary. PMID:27273092

  11. The prevalence and significance of substance use disorders in bipolar type I and II disorder

    PubMed Central

    Cerullo, Michael A; Strakowski, Stephen M

    2007-01-01

    The aim of this paper is to provide a systematic review of the literature examining the epidemiology, outcome, and treatment of patients with bipolar disorder and co-occurring substance use disorders (SUDs). Articles for this review were initially selected via a comprehensive Medline search and further studies were obtained from the references in these articles. Given the lack of research in this field, all relevant studies except case reports were included. Prior epidemiological research has consistently shown that substance use disorders (SUDs) are extremely common in bipolar I and II disorders. The lifetime prevalence of SUDs is at least 40% in bipolar I patients. Alcohol and cannabis are the substances most often abused, followed by cocaine and then opioids. Research has consistently shown that co-occurring SUDs are correlated with negative effects on illness outcome including more frequent and prolonged affective episodes, decreased compliance with treatment, a lower quality of life, and increased suicidal behavior. Recent research on the causal relationship between the two disorders suggests that a subgroup of bipolar patients may develop a relatively milder form of affective illness that is expressed only after extended exposure to alcohol abuse. There has been very little treatment research specifically targeting this population. Three open label medication trials provide limited evidence that quetiapine, aripiprazole, and lamotrigine may be effective in treating affective and substance use symptoms in bipolar patients with cocaine dependence and that aripiprazole may also be helpful in patients with alcohol use disorders. The two placebo controlled trials to date suggest that valproate given as an adjunct to lithium in bipolar patients with co-occurring alcohol dependence improves both mood and alcohol use symptoms and that lithium treatment in bipolar adolescents improves mood and SUD symptoms. Given the high rate of SUD co-occurrence, more research

  12. Recent progress in understanding pediatric bipolar disorder.

    PubMed

    Goldstein, Benjamin I

    2012-04-01

    Bipolar disorder is one of the most severe psychiatric illnesses, particularly when onset occurs during childhood or adolescence. With recent empirical evidence, questions regarding the existence of bipolar disorder among children and adolescents have given way to questions regarding prevalence. There are substantial risks inherent in misapplying diagnoses and treatments of bipolar disorder when not warranted and in withholding these diagnoses and treatments when they are warranted. As with adults, the course of bipolar disorder among children and adolescents diagnosed using unmodified diagnostic criteria is characterized by recovery and recurrence, functional impairment, suicidality, and high rates of comorbid psychiatric and medical problems. Discrepancies between increasing billing diagnoses and a stable epidemiologic prevalence of bipolar disorder suggest the possibility that diagnostic criteria are not being systematically applied in some clinical settings. Introducing new diagnoses may exacerbate rather than mitigate concerns regarding misdiagnosis and excessive use of mood-stabilizing medications. Several medications, particularly second-generation antipsychotics, are efficacious for treating acute manic episodes of bipolar I disorder. However, less is known regarding the treatment of other mood states and subtypes of bipolar disorder. Psychosocial treatments provide a forum in which to educate children and families regarding bipolar disorder and its treatment, and may be especially beneficial for reducing depressive symptoms. Offspring of parents with bipolar disorder are at increased risk of developing the illness, as are youth with major depressive disorder and certain psychiatric comorbidities. Preliminary findings regarding biomarkers offer hope that, in the future, these biomarkers may inform diagnostic and treatment decisions. PMID:22213607

  13. Pachymetric Changes of the Cornea Amongst Patients Treated with LASIK

    PubMed Central

    Shabani, Afrim; Asani, Minir; Kaçaniku, Gazmend; Ajazaj, Valbon; Dida, Ermal; Lutaj, Pajtim

    2015-01-01

    Purpose: In this study, we have researched the possible parametrically changes before and after LASIK (laser-assisted in situ keratomileusis) and the influence of these changes in the cause of post LASIK ectasia. Materials and methods: In this study 204 eyes with different refractive anomalies were included. Candidates that underwent refractive surgery first have to undergo many ophthalmological examinations, firstly by evaluating their visual acuity, subjective and objective refraction with and without cycloplegia, slight lamp evaluation, computerized topography, pupillometry, retina examination and measurement of intraocular pressure. Pachymetric values were measured with Orbscan IIz (Bausch – Lomb). Refractive surgery was done with LASIK under local anesthesia. Results: In this study 102 patients were treated with LASIK who were with different refractive anomalies. According to the group age 44 or 43.1% were of the age 20 – 29, 46 or 45.1% were of the age 30 – 39, 11 or 10.8% were 40 – 49 years of age and 1 or 1% were above the age of 50 +. Pachymetric before surgery in right eye was approximately 565.4 µm (DS+- 39.4), from 507 µm up to 678 µm, but after surgery it was approximately 497.5 µm (DS+-61.7) from 346 µm up to 644 µm. Pachymetric on the left eye before surgery was approximately 564.8 µm (DS+-41.5) from 504 µm up to 696 µm but after surgery it was approximately 498.3 µm (DS+-62.2), from 329 µm up to 646 µm. Pachymetric in both eyes before surgery was approximately 549.1 µm (DS+=73.9), from 263 µm up to 687 µm. Pachymetric on both eyes after surgery was approximately 496.9 µm (DS+-60.1), from 337.5 µm up to 645 µm. With the “ Paired T – test “ we have reached a significant statistical change between the pachymetric values in both eyes before and after the surgery (P<0.0001). Conclusion: Corneal thickness is one of the main criteria in order to allow refractive surgeries, and as the main criteria it was evaluated at our

  14. A Meta-Analysis of Neuropsychological Functioning in Patients with Early Onset Schizophrenia and Pediatric Bipolar Disorder

    ERIC Educational Resources Information Center

    Nieto, Rebeca Garcia; Castellanos, F. Xavier

    2011-01-01

    Despite the nosological distinction between bipolar disorder and schizophrenia, there is increasing evidence that these conditions share phenomenological characteristics. To examine the similarities in their patterns of cognitive impairment, we conducted a meta-analysis from 12 studies of Early Onset Schizophrenia (EOS) and 12 studies of Pediatric…

  15. Comparative efficacy and tolerability of drug treatments for bipolar disorder.

    PubMed

    Strakowski, S M; DelBello, M P; Adler, C M

    2001-01-01

    Lithium has been the backbone of treatment for bipolar disorder for several decades, although recent advances have identified a number of other medications that have efficacy in treating various phases of the illness. These include the antiepileptic drugs valproate semisodium (divalproex sodium) and carbamazepine and some new antiepileptic drugs (e.g. lamotrigine and topiramate), and the atypical antipsychotics (e.g. olanzapine, clozapine and risperidone). Conventional antipsychotics continue to be used frequently in bipolar disorder, although they may be somewhat less effective than other treatments. Otherwise, to date, none of these treatments have been shown to be consistently more effective than any other, so that drug adverse effects and tolerability often dictate which agents are used in an individual patient. Drugs commonly used for the treatment of bipolar disorder are generally tolerated by most patients in large samples. However, the unique adverse effect signature of a drug will often suggest that it will be less tolerable in some patients than in others. Identifying a specific treatment for a specific patient requires a careful individualised assessment of the risk of adverse effects for that patient's unique circumstances. PMID:11580309

  16. The number of past manic episodes is the best predictor of antidepressant-emergent manic switch in a cohort of bipolar depressed patients.

    PubMed

    Gorwood, Philip; Richard-Devantoy, Stéphane; Sentissi, Othman; Le Strat, Yann; Olié, Jean Pierre

    2016-06-30

    The present study sought to identify factors associated with the onset of a manic or hypomanic episode during the month following a new antidepressant therapy in depressed bipolar patients. Patients receiving mood stabilizers for ≥3 months were screened from 400 French centers and were assessed for a 4-week period following prescription of a first or a new antidepressant. Of the 1242 included participants, 4.8% (n=60) experienced antidepressant-emergent manic switch (AEMS). AEMS was more frequently associated with lifetime manic, depressive, and total mood episodes, and with past AEMS. A higher score at two items of the Montgomery-Åsberg Depression Rating Scale (pessimistic and suicidal thoughts) were significantly associated with AEMS. Logistic regression analysis showed that the number of lifetime manic episodes and past AEMS were the two most factors associated with an AEMS. Having more than four past manic episodes was associated with a 2.84 fold increased risk of AEMS. Cumulative number of past mood episodes seems to be the most important factor for switching to a manic episode following antidepressants in patients with bipolar disorder. Longer-term studies are required to further delineate antidepressant causality from natural disease course. PMID:27138820

  17. Olanzapine approved for the acute treatment of schizophrenia or manic/mixed episodes associated with bipolar I disorder in adolescent patients

    PubMed Central

    Maloney, Ann E; Sikich, Linmarie

    2010-01-01

    Background Severe and persistent mental illnesses in children and adolescents, such as early- onset schizophrenia spectrum (EOSS) disorders and pediatric bipolar disorder (pedBP), are increasingly recognized. Few treatments have demonstrated efficacy in rigorous clinical trials. Enduring response to current medications appears limited. Recently, olanzapine was approved for the treatment of adolescents with schizophrenia or acute manic/mixed episodes in pedBP. Methods PubMed searches were conducted for olanzapine combined with pharmacology, schizophrenia, or bipolar disorder. Searches related to schizophrenia and bipolar disorder were limited to children and adolescents. The bibliographies of the retrieved articles were hand-checked for additional relevant studies. The epidemiology, phenomenology, and treatment of EOSS and pedBP, and olanzapine’s pharmacology are reviewed. Studies of olanzapine treatment in youth with EOSS and pedBP are examined. Results Olanzapine is efficacious for EOSS and pedBP. However, olanzapine is not more efficacious than risperidone, molindone, or haloperidol in EOSS and is less efficacious than clozapine in treatment-resistant EOSS. No comparative trials have been done in pedBP. Olanzapine is associated with weight gain, dyslipidemia, and transaminase elevations in youth. Extrapyramidal symptoms, neuroleptic malignant syndrome, and blood dyscrasias have also been reported but appear rare. Conclusions The authors conclude that olanzapine should be considered a second-line agent in EOSS and pedBP due to its risks for significant weight gain and lipid dysregulation. Awareness of the consistent weight and metabolic changes observed in olanzapine-treated youth focused attention on the potential long-term risks of atypical antipsychotics in youth. PMID:21127693

  18. Rational polypharmacy in the bipolar affective disorders.

    PubMed

    Post, R M; Ketter, T A; Pazzaglia, P J; Denicoff, K; George, M S; Callahan, A; Leverich, G; Frye, M

    1996-01-01

    Bipolar affective illness represents a syndrome not readily treated by single agents. Approximately 50% of patients are inadequately responsive to lithium and the majority of patients require supplemental antidepressants, antimanic, antipsychotic or hypnotic medications. These traditional adjunctive medications are associated with potential problems. Antidepressants may precipitate mania (at a rate about double that of placebo) or cause cycle acceleration. Neuroleptics may be associated with either more profound or longer depressive phases, and clearly increase the risk of tardive dyskinesia, to which bipolar patients appear particularly predisposed. Moreover, there are subgroups of patients who are known to be poorly responsive to lithium. These include patients with rapid cycling, dysphoric mania, co-morbid drug or alcohol abuse, a pattern of depression-mania-well interval (D-M-I as opposed to the M-D-I pattern), and patients without a family history of bipolar illness in first-degree relatives. There is increasing recognition that the anticonvulsants carbamazepine and valproate are effective alternatives or adjuncts to lithium in the acute and long-term treatment of bipolar illness. Ideally, one would want to assess whether patients who were unresponsive to lithium were responsive to an anticonvulsant alone prior to utilizing lithium in addition to anticonvulsant combination therapy. However, from the clinical perspective, it is often more expedient to use an anticonvulsant adjunctively to lithium to assess the efficacy of this combination and establish mood stabilization. When lithium is not discontinued, the increased morbidity during lithium withdrawal also would not occur and would not confound the evaluation of the new agent. We suggest the initial use of acute adjuncts to lithium with the anticonvulsants carbamazepine or valproate (instead of neuroleptics) so that their efficacy can be assessed in the individual's acute episode, with the likelihood of a

  19. How Childhood Maltreatment Is Related to Suicidality, Bipolarity and Central Serotonergic Activity in Patients with Major Depressive Disorder: A Cross-Sectional Pilot Study

    PubMed Central

    Lee, Bun-Hee

    2016-01-01

    Objective The aims of this study were to determine whether childhood maltreatment contributes to the occurrence of major depressive disorder (MDD) with bipolarity, and whether there is a relationship between central serotonergic activity, as assessed using loudness dependence of auditory evoked potentials (LDAEP), and childhood maltreatment. Methods Thirty-five MDD patients were stratified according to the presence or absence of childhood trauma into two subgroups, childhood trauma (CT) and no childhood trauma (NCT), using the Korean version of the Childhood Trauma Questionnaire (K-CTQ). The CT group was subjected to further analysis. Several psychometric ratings were also applied. In addition, auditory processing for the loudness dependence of auditory evoked potentials (LDAEP), which was used as a marker of serotonergic activity, was measured before beginning medication. Results There was a significant difference in total Korean Bipolar Spectrum Disorder Scale score between the CT and NCT groups (t=-2.14, p=0.04). The total K-CTQ score was positively correlated with the total Beck Scale for Suicidal Ideation (BSS) score (r=0.36, p=0.036). In particular, emotional abuse was positively correlated with the total Barratt Impulsiveness Scale (r=0.38, p=0.026), BSS (r=0.38, p=0.025), and Hamilton Depression Rating Scale (HAMD) (r=0.36, p=0.035) scores. There was also a positive correlation between LDAEP and total Hypomania Personality Scale (r=0.49, p=0.02) and HAMD (r=0.58, p=0.004) scores within CT group. Conclusion The findings of this study support that there is a relationship between childhood maltreatment and bipolarity in patients with MDD. PMID:27081379

  20. Targeting astrocytes in bipolar disorder.

    PubMed

    Peng, Liang; Li, Baoman; Verkhratsky, Alexei

    2016-06-01

    Astrocytes are homeostatic cells of the central nervous system, which are critical for development and maintenance of synaptic transmission and hence of synaptically connected neuronal ensembles. Astrocytic densities are reduced in bipolar disorder, and therefore deficient astroglial function may contribute to overall disbalance in neurotransmission and to pathological evolution. Classical anti-bipolar drugs (lithium salts, valproic acid and carbamazepine) affect expression of astroglial genes and modify astroglial signalling and homeostatic cascades. Many effects of both antidepressant and anti-bipolar drugs are exerted through regulation of glutamate homeostasis and glutamatergic transmission, through K(+) buffering, through regulation of calcium-dependent phospholipase A2 (that controls metabolism of arachidonic acid) or through Ca(2+) homeostatic and signalling pathways. Sometimes anti-depressant and anti-bipolar drugs exert opposite effects, and some effects on gene expression in drug treated animals are opposite in neurones vs. astrocytes. Changes in the intracellular pH induced by anti-bipolar drugs affect uptake of myo-inositol and thereby signalling via inositoltrisphosphate (InsP3), this being in accord with one of the main theories of mechanism of action for these drugs. PMID:27015045

  1. The differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I and II

    PubMed Central

    Izci, Filiz; Fındıklı, Ebru Kanmaz; Zincir, Serkan; Zincir, Selma Bozkurt; Koc, Merve Iris

    2016-01-01

    Background The primary aim of this study was to compare the differences in temperament–character traits, suicide attempts, impulsivity, and functionality levels of patients with bipolar disorder I (BD-I) and bipolar disorder II (BD-II). Methods Fifty-two BD-I patients and 49 BD-II patients admitted to Erenköy Mental and Neurological Disease Training and Research Hospital psychiatry clinic and fifty age- and sex-matched healthy control subjects were enrolled in this study. A structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders, Temperament and Character Inventory, Barrett Impulsiveness Scale-11 (BIS-11), Hamilton Depression Inventory Scale, Young Mania Rating Scale, and Bipolar Disorder Functioning Questionnaire (BDFQ) were administered to patients and to control group. Results No statistically significant difference in sociodemographic features existed between the patient and control groups (P>0.05). Thirty-eight subjects (37.62%) in the patient group had a suicide attempt. Twenty-three of these subjects (60.52%) had BD-I, and 15 of these subjects (39.47%) had BD-II. Suicide attempt rates in BD-I and II patients were 60.52% and 39.47%, respectively (P<0.05). Comparison of BD-I and II patients with healthy control subjects revealed that cooperativeness (C), self-directedness (Sdi), and self-transcendence (ST) scores were lower and novelty seeking (NS1 and NS2), harm avoidance (HA4), and reward dependence (RD2) subscale scores were higher in patients with BD-I. When BD-I patients were compared with BD-II patients, BIS-11 (attention) scores were higher in patients with BD-II and BIS-11 (motor and nonplanning impulsivity) scores were higher in patients with BD-I. According to BDFQ, relations with friends, participation in social activities, daily activities and hobbies, and occupation subscale scores were lower and taking initiative subscale scores were higher in patients with BD-I. Social withdrawal

  2. Diagnosing and treating renal disease in cirrhotic patients.

    PubMed

    Wong, Florence

    2016-09-01

    Renal dysfunction in cirrhosis is mostly related to the development of acute kidney injury (AKI), precipitated by either an acute disturbance of hemodynamics, or acute structural damage to the kidneys. The incidence of chronic renal failure is rising, due to increasing prevalence of conditions such as diabetes, viral hepatitis, which can be associated with renal damage. AKI is defined as a rise in serum creatinine of 0.3 mg/dL in <48 hours or by 50% from baseline within the past 3 months without setting a threshold for the final serum creatinine. Stages 1, 2, and 3 of AKI are defined as 150%, 200% and 300% of baseline serum creatinine respectively, which allows for assessment of AKI progression. Chronic kidney disease (CKD) is defined as an estimated glomerular filtration rate of <60 mL/min for >3 months. Treatment of AKI consists of removal of precipitating factors and replenishment of the intravascular volume using colloids such as albumin. Frequently, AKI can be reversed using these measures alone. Non-responders to removal of precipitating factors and volume challenge can receive vasoconstrictors such as terlipressin or norepinephrine together with albumin. Midodrine is inferior in efficacy as a vasoconstrictor when compared to terlipressin. Liver transplantation is the definitive treatment for type 1 hepatorenal syndrome with liver failure. Delay in receiving a liver transplant can result in non-recovery of renal function post transplant. Treatment of CKD in cirrhosis is unsatisfactory, mostly aimed at optimizing management of comorbid conditions, or treating the underlying refractory ascites in patients with type 2 hepatorenal syndrome. PMID:27096702

  3. Facial expression in patients with bipolar disorder and schizophrenia in response to emotional stimuli: a partially shared cognitive and social deficit of the two disorders

    PubMed Central

    Bersani, Giuseppe; Polli, Elisa; Valeriani, Giuseppe; Zullo, Daiana; Melcore, Claudia; Capra, Enrico; Quartini, Adele; Marino, Pietropaolo; Minichino, Amedeo; Bernabei, Laura; Robiony, Maddalena; Bersani, Francesco Saverio; Liberati, Damien

    2013-01-01

    Introduction It has recently been highlighted that patients affected by schizophrenia (SCZ) and those affected by bipolar disorder (BD) undergo gradual chronic worsening of cognitive and social functioning. The objective of the current study was to evaluate and compare (using the Facial Action Coding System [FACS]) the way by which patients with the two disorders experience and display emotions in relation to specific emotional stimuli. Materials and methods Forty-five individuals participated in the study: 15 SCZ patients, 15 BD patients, and 15 healthy controls. All participants watched emotion-eliciting video clips while their facial activity was videotaped. The congruent/incongruent feeling of emotions and the facial expression in reaction to emotions were evaluated. Results SCZ and BD patients presented similar incongruent emotive feelings and facial expressions (significantly worse than healthy participants); SCZ patients expressed the emotion of disgust significantly less appropriately than BD patients. Discussion BD and SCZ patients seem to present a similar relevant impairment in both experiencing and displaying emotions; this impairment may be seen as a behavioral indicator of the deficit of social cognition present in both the disorders. As the disgust emotion is mainly elaborated in the insular cortex, the incongruent expression of disgust of SCZ patients can be interpreted as a further evidence of a functional deficit of the insular cortex in this disease. Specific remediation training could be used to improve emotion and social cognition in SCZ and BD patients. PMID:23966784

  4. Facial Emotion Recognition in First-Episode Schizophrenia and Bipolar Disorder with Psychosis

    PubMed Central

    Daros, Alexander R.; Ruocco, Anthony C.; Reilly, James L.; Harris, Margret S. H.; Sweeney, John A.

    2014-01-01

    Patients with schizophrenia and bipolar disorder have difficulties recognizing facial expressions of emotion. Differences in deficits between these disorders and the effects of treating acute symptoms of illness with antipsychotic medication on these deficits are not well characterized. First-episode patients with schizophrenia (n = 24) and psychotic bipolar I disorder (n = 16) were compared to a healthy control group (n = 32) on the Penn Emotional Acuity Test. Patients were studied during an acute psychotic episode and after seven weeks of treatment with antipsychotic medication. During acute psychosis, bipolar patients showed deficits recognizing subtle facial expressions of happiness and sadness, and this deficit did not resolve with treatment. Schizophrenia patients similarly had difficulty recognizing subtle happy faces during acute illness that also did not resolve with treatment. In addition, problems recognizing subtle expressions of sadness among schizophrenia patients were apparent after treatment. Poorer emotion recognition at follow-up was related to negative symptom severity for schizophrenia patients. These findings highlight the severity and persistence of emotion recognition deficits early in the course of psychotic bipolar disorder and schizophrenia, and demonstrate an association of emotion processing deficits to negative symptoms in schizophrenia during periods of relative clinical stability. PMID:24457036

  5. Facial emotion recognition in first-episode schizophrenia and bipolar disorder with psychosis.

    PubMed

    Daros, Alexander R; Ruocco, Anthony C; Reilly, James L; Harris, Margret S H; Sweeney, John A

    2014-03-01

    Patients with schizophrenia and bipolar disorder have difficulties recognizing facial expressions of emotion. Differences in deficits between these disorders and the effects of treating acute symptoms of illness with antipsychotic medication on these deficits are not well characterized. First-episode patients with schizophrenia (n=24) and psychotic bipolar I disorder (n=16) were compared to a healthy control group (n=32) on the Penn Emotional Acuity Test. Patients were studied during an acute psychotic episode and after seven weeks of treatment with antipsychotic medication. During acute psychosis, bipolar patients showed deficits recognizing subtle facial expressions of happiness and sadness, and this deficit did not resolve with treatment. Schizophrenia patients similarly had difficulty recognizing subtle happy faces during acute illness that also did not resolve with treatment. In addition, problems recognizing subtle expressions of sadness among schizophrenia patients were apparent after treatment. Poorer emotion recognition at follow-up was related to negative symptom severity for schizophrenia patients. These findings highlight the severity and persistence of emotion recognition deficits early in the course of psychotic bipolar disorder and schizophrenia, and demonstrate an association of emotion processing deficits to negative symptoms in schizophrenia during periods of relative clinical stability. PMID:24457036

  6. Managing patients with bipolar disorder at home: a family affair and a psychiatric challenge in home healthcare.

    PubMed

    Carson, Verna Benner; Yambor, Sandra L

    2012-05-01

    Medicare has covered psychiatric home care for many years, but the delivery of psychiatric services in the home continues to raise questions related to coverage and criteria. What services do psychiatric nurses provide in the home? What are the rules and regulations governing this service? This article presents information related to psychiatric nursing in home care and specifically bipolar disease. These questions are answered within Chapter 7 of the Medicare Benefit Policy Manual, April 2011. Section 40.1.2.15. PMID:22565349

  7. Bipolar disorder diagnosis: challenges and future directions.

    PubMed

    Phillips, Mary L; Kupfer, David J

    2013-05-11

    Bipolar disorder refers to a group of affective disorders, which together are characterised by depressive and manic or hypomanic episodes. These disorders include: bipolar disorder type I (depressive and manic episodes: this disorder can be diagnosed on the basis of one manic episode); bipolar disorder type II (depressive and hypomanic episodes); cyclothymic disorder (hypomanic and depressive symptoms that do not meet criteria for depressive episodes); and bipolar disorder not otherwise specified (depressive and hypomanic-like symptoms that do not meet the diagnostic criteria for any of the aforementioned disorders). Bipolar disorder type II is especially difficult to diagnose accurately because of the difficulty in differentiation of this disorder from recurrent unipolar depression (recurrent depressive episodes) in depressed patients. The identification of objective biomarkers that represent pathophysiologic processes that differ between bipolar disorder and unipolar depression can both inform bipolar disorder diagnosis and provide biological targets for the development of new and personalised treatments. Neuroimaging studies could help the identification of biomarkers that differentiate bipolar disorder from unipolar depression, but the problem in detection of a clear boundary between these disorders suggests that they might be better represented as a continuum of affective disorders. Innovative combinations of neuroimaging and pattern recognition approaches can identify individual patterns of neural structure and function that accurately ascertain where a patient might lie on a behavioural scale. Ultimately, an integrative approach, with several biological measurements using different scales, could yield patterns of biomarkers (biosignatures) to help identify biological targets for personalised and new treatments for all affective disorders. PMID:23663952

  8. Safety and effectiveness of divalproex sodium extended release containing regimen in Indian patients with bipolar I disorder in continuation phase: Results of EASED registry.

    PubMed

    Shah, Nilesh; Reddy, M S; Vohra, Sandeep; Chaudhuri, Uday; Mohanasundaram, Senthilnathan

    2016-04-01

    The study was conducted to evaluate the safety and effectiveness of divalproex sodium XR containing regimen in patients with bipolar disorder (BPD) who are in continuation phase. It was an open-label, prospective, observational study conducted from July 2010 to December 2011 at 48 sites across India. Adult patients with bipolar I disorder of manic or mixed type fulfilling the DSM-IV criteria and who were in the continuation phase were included. Safety (primary outcome) was assessed by incidence of treatment emergent adverse events (AEs). Effectiveness (secondary outcome), was evaluated by proportion of patients who did not have a relapse, change in Clinical Global Impression Score-BP version-Severity of Illness (CGI-BP) and Young's Mania Rating Scale (YMRS) score. Data was recorded at three visits: visit-1 (baseline), visit-2 (end of 2 months ± 7 days) and visit-3 (end of 4 months ± 14 days), and summarised using descriptive statistics. p<0.05 was considered statistically significant. A total of 489 and 468 patients were included in the safety and effectiveness analyses, respectively. Of the 66 AEs reported, 57 (89.0%) were mild and 7 (10.9%) were moderate (data missing for 2 events). In total, 75.0% (48/64) of the AEs were related to the study drug. No serious AEs reported (N=64). No relapse observed in 93.3% of patients. There was a significant (p<0.0001) reduction in the YMRS and CGI-BP scores from baseline to visit-3. Our study confirms the results of earlier studies in terms of good tolerability and effectiveness of divalproex sodium XR containing regimen in this study population. PMID:27025469

  9. Brain lithium, N-acetyl aspartate and myo-inositol levels in older adults with bipolar disorder treated with lithium: a lithium-7 and proton magnetic resonance spectroscopy study

    PubMed Central

    Forester, Brent P; Finn, Chelsea T; Berlow, Yosef A; Wardrop, Megan; Renshaw, Perry F; Moore, Constance M

    2014-01-01

    Objectives We investigated the relationship between brain lithium levels and the metabolites N-acetyl aspartate (NAA) and myo-inositol (myo-Ino) in the anterior cingulate cortex of a group of older adults with bipolar disorder (BD). Methods This cross-sectional assessment included nine subjects (six males and three females) with bipolar I disorder and currently treated with lithium, who were examined at McLean Hospital’s Geriatric Psychiatry Research Program and Brain Imaging Center. The subjects’ ages ranged from 56 to 85 years (66.0 ± 9.7 years) and all subjects had measurements of serum and brain lithium levels. Brain lithium levels were assessed using lithium magnetic resonance spectroscopy. All subjects also had proton magnetic resonance spectroscopy to obtain measurements of NAA and myo-Ino. Results Brain lithium levels were associated with higher NAA levels [df = (1, 8), B = 12.53, t = 4.09, p < 0.005] and higher myo-Ino levels [df = (1, 7), F = 16.81, p < 0.006]. There were no significant effects of serum lithium levels on any of the metabolites. Conclusion Our findings of a relationship between higher brain lithium levels and elevated NAA levels in older adult subjects with BD may support previous evidence of lithium’s neuroprotective, neurotrophic, and mitochondrial function-enhancing effects. Elevated myo-Ino related to elevated brain lithium levels may reflect increased inositol monophosphatase (IMPase) activity, which would lead to an increase in myo-Ino levels. This is the first study to demonstrate alterations in NAA and myo-Ino in a sample of older adults with BD treated with lithium. PMID:18837863

  10. Mathematical models of bipolar disorder

    NASA Astrophysics Data System (ADS)

    Daugherty, Darryl; Roque-Urrea, Tairi; Urrea-Roque, John; Troyer, Jessica; Wirkus, Stephen; Porter, Mason A.

    2009-07-01

    We use limit cycle oscillators to model bipolar II disorder, which is characterized by alternating hypomanic and depressive episodes and afflicts about 1% of the United States adult population. We consider two non-linear oscillator models of a single bipolar patient. In both frameworks, we begin with an untreated individual and examine the mathematical effects and resulting biological consequences of treatment. We also briefly consider the dynamics of interacting bipolar II individuals using weakly-coupled, weakly-damped harmonic oscillators. We discuss how the proposed models can be used as a framework for refined models that incorporate additional biological data. We conclude with a discussion of possible generalizations of our work, as there are several biologically-motivated extensions that can be readily incorporated into the series of models presented here.

  11. Bipolar Transurethral Incision of Bladder Neck Stenoses with Mitomycin C Injection

    PubMed Central

    Lyon, Timothy D.; Ayyash, Omar M.; Ferroni, Matthew C.; Rycyna, Kevin J.; Chen, Mang L.

    2015-01-01

    Introduction. To determine the efficacy of bipolar transurethral incision with mitomycin C (MMC) injection for the treatment of refractory bladder neck stenosis (BNS). Materials and Methods. Patients who underwent bipolar transurethral incision of BNS (TUIBNS) with MMC injection at our institution from 2013 to 2014 were retrospectively reviewed. A total of 2 mg of 40% mitomycin C solution was injected in four quadrants of the treated BNS. Treatment failure was defined as the need for subsequent intervention. Results. Thirteen patients underwent 17 bipolar TUIBNS with MMC injection. Twelve (92%) patients had failed a mean of 2.2 ± 1.1 prior endoscopic procedures. Median follow-up was 16.5 months (IQR: 14–18.4 months). Initial success was 62%; five (38%) patients had a recurrence with a median time to recurrence of 7.3 months. Four patients underwent a repeat procedure, 2 (50%) of which failed. Overall success was achieved in 77% (10/13) of patients after a mean of 1.3 ± 0.5 procedures. BNS recurrence was not significantly associated with history of pelvic radiation (33% versus 43%, p = 0.9). There were no serious adverse events. Conclusions. Bipolar TUIBNS with MMC injection was comparable in efficacy to previously reported techniques and did not result in any serious adverse events. PMID:26635876

  12. Personality Disorders in Substance Abusers: A Comparison of Patients Treated in a Prison Unit and Patients Treated in Inpatient Treatment

    ERIC Educational Resources Information Center

    Stefansson, Ragnar; Hesse, Morten

    2008-01-01

    A large body of literature has shown a high prevalence of personality disorders in substance abusers. We compared a sample of substance abusers treated in a prison setting with substance abusers treated in a non-prison inpatient setting rated with the Millon Clinical Multiaxial Inventory-III. Base-rate scores indicated a prevalence of 95% of…

  13. Label-free, live optical imaging of reprogrammed bipolar disorder patient-derived cells reveals a functional correlate of lithium responsiveness.

    PubMed

    Wang, J L; Shamah, S M; Sun, A X; Waldman, I D; Haggarty, S J; Perlis, R H

    2014-01-01

    Development of novel treatments and diagnostic tools for psychiatric illness has been hindered by the absence of cellular models of disease. With the advent of cellular reprogramming, it may be possible to recapitulate the disease biology of psychiatric disorders using patient skin cells transdifferentiated to neurons. However, efficiently identifying and characterizing relevant neuronal phenotypes in the absence of well-defined pathophysiology remains a challenge. In this study, we collected fibroblast samples from patients with bipolar 1 disorder, characterized by their lithium response (n=12), and healthy control subjects (n=6). We identified a cellular phenotype in reprogrammed neurons using a label-free imaging assay based on a nanostructured photonic crystal biosensor and found that an optical measure of cell adhesion was associated with clinical response to lithium treatment. This cellular phenotype may represent a useful biomarker to evaluate drug response and screen for novel therapeutics. PMID:25158003

  14. [Clinical relevance of antidepressant-induced activation syndrome: from a perspective of bipolar spectrum disorder].

    PubMed

    Tanaka, Teruaki; Inoue, Takeshi; Suzuki, Katsuji; Kitaichi, Yuji; Masui, Takuya; Denda, Kenzo; Koyama, Tsukasa

    2007-01-01

    Recent concerns have been raised regarding whether antidepressants, especially selective serotonin reuptake inhibitors (SSRIs) might increase suicidal tendencies and intense debate-rages over the pros and cons of their use. Although systematic reviews and population-based studies have been conducted, a consensus on this association remains to be established. Subsequently, the concept of so-called 'activation syndrome' associated with antidepressants has been accepted without its adequate verification. In the present report, we present our experience of seven cases considered of having 'activation syndrome' brought on by antidepressants, and examine its clinical relevance to bipolar spectrum disorder (Ghaemi, et al., 2001) both symptomatologically and diagnostically. Five patients, diagnosed as having major depressive disorder according to the diagnostic manual (DSM-IV), met the criteria of bipolar spectrum disorder and suffered from activation syndrome following the administration of SSRIs, mainly paroxetine. Similarly, hypomania developed in all five cases with depression; the diagnostic criteria of a hypomanic episode were not met. In the remaining two patients, who were both diagnosed with bipolar disorder, one showed irritability and insomnia through imipramine use, and the another developed a hypomanic and/or a mixed state after the co-administration of fluvoxamine and trazodone. From the results of our examination, 'bipolarity', which is the pivotal factor of bipolar spectrum, might exist behind the phenomenon recognized as activation syndrome, and be revealed by antidepressant treatment, just like manic switching. Moreover, the various problems encountered in the current practice of treating mood disorders, including unipolar-bipolar dichotomy, manic switching by antidepressants, and narrow criteria for a mixed episode, were pointed out a new through this concept of activation syndrome. Actually, the understanding of activation syndrome clinically leads to

  15. Bipolar offspring: a window into bipolar disorder evolution.

    PubMed

    Chang, Kiki; Steiner, Hans; Dienes, Kimberly; Adleman, Nancy; Ketter, Terence

    2003-06-01

    Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study with potential for illumination of prodromal forms of bipolar disorder. Due to their high-risk nature, bipolar offspring may present phenomenological, temperamental, and biological clues to early presentations of bipolar disorder. This article reviews the evidence for establishing bipolar offspring as a high-risk cohort, the studies which point to possible prodromal states in bipolar offspring, biological findings in bipolar offspring which may be indicators of even higher risk for bipolar disorder, initial attempts at early intervention in prodromal pediatric bipolar disorder, and implications for future research. PMID:12788239

  16. Bipolar disorder in women

    PubMed Central

    Parial, Sonia

    2015-01-01

    Bipolar affective disorder in women is a challenging disorder to treat. It is unique in its presentation in women and characterized by later age of onset, seasonality, atypical presentation, and a higher degree of mixed episodes. Medical and psychiatric co-morbidity adversely affects recovery from the bipolar disorder (BD) more often in women. Co-morbidity, particularly thyroid disease, migraine, obesity, and anxiety disorders occur more frequently in women while substance use disorders are more common in men. Treatment of women during pregnancy and lactation is challenging. Pregnancy neither protects nor exacerbates BD, and many women require continuation of medication during the pregnancy. The postpartum period is a time of high risk for onset and recurrence of BD in women. Prophylaxis with mood stabilizers might be needed. Individualized risk/benefits assessments of pregnant and postpartum women with BD are required to promote the health of the women and to avoid or limit exposure of the fetus or infant to potential adverse effects of medication. PMID:26330643

  17. Transdiagnostic Treatment of Bipolar Disorder and Comorbid Anxiety with the Unified Protocol: A Clinical Replication Series

    PubMed Central

    Ellard, Kristen K.; Deckersbach, Thilo; Sylvia, Louisa G.; Nierenberg, Andrew A.; Barlow, David H.

    2013-01-01

    Bipolar disorder (BD) is a chronic, debilitating disorder with recurrent manic and depressive episodes. Over 75% of bipolar patients have a current or lifetime diagnosis of a comorbid anxiety disorder. Comorbid anxiety in BD is associated with greater illness severity, greater functional impairment, and poorer illness-related outcomes. Effectively treating comorbid anxiety in individuals with BD has been recognized as one of the biggest unmet needs in the field of bipolar disorder. Recently, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) was developed to be applicable to the full range of anxiety and mood disorders, based upon converging evidence from genetics, cognitive and affective neuroscience, and behavioral research suggesting common, core emotion-related pathology. Here, we present a preliminary evaluation of the efficacy of the UP for the treatment of BD with comorbid anxiety, in a clinical replication series consisting of three cases. PMID:22822175

  18. Anaplastic thyroid carcinoma: 91 patients treated by surgery and radiotherapy.

    PubMed

    Junor, E J; Paul, J; Reed, N S

    1992-04-01

    Ninety-one patients with histologically proven anaplastic carcinoma of the thyroid were referred to the Beatson Oncology Centre between 1961 and 1986. The female:male ratio was 2.4:1 and the median age at presentation was 70 (range 38-92) years. All patients had a thyroid mass at presentation and the most common symptoms were dyspnoea, dysphagia and dysphonia. Five patients had a total thyroidectomy and 28 partial thyroidectomy. Ninety five per cent of patients received external beam radiotherapy. Results show dyspnoea to be the only symptom strongly influencing survival. Total or partial thyroidectomy is associated with increased survival. This association is most marked for patients presenting without dyspnoea. Eighty per cent of patients responded to radiotherapy. PMID:1582515

  19. Tardive dyskinesia in 2 patients treated with ziprasidone

    PubMed Central

    Ananth, Jambur; Burgoyne, Karl S.; Niz, David; Smith, Michael

    2004-01-01

    Ziprasidone is an atypical antipsychotic drug that is believed to have a low propensity for inducing extrapyramidal symptoms, including tardive dyskinesia (TD). Two of our patients developed TD after 23 months and 34 months of ziprasidone monotherapy, respectively. One of the patients had had earlier exposure to typical antipsychotic drugs, but no other predisposing factors for TD were noted. Therefore, patients on long-term therapy with atypical antipsychotic drugs should be screened periodically for TD. PMID:15644988

  20. Ecthyma gangrenosum caused by Pseudomonas aeruginosa in a patient with astrocytoma treated with chemotherapy.

    PubMed

    De Vos, Filip Yves Francine Léon; Middelburg, Tom Alexander; Seynaeve, Caroline; de Jonge, Maja J A

    2010-02-01

    Ecthyma gangrenosum, presenting as embolic lesions caused by Pseudomonas aeruginosa infection, has distinct pathognomonic features and a high mortality rate in patients with bacteremia, but when recognized early is easily treated. In this case report we describe this disseminated infection in an adult patient treated with chemotherapy for an astrocytoma. PMID:20054603

  1. Ixabepilone in Treating Young Patients With Refractory Solid Tumors

    ClinicalTrials.gov

    2014-11-13

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Alveolar Childhood Rhabdomyosarcoma; Childhood Synovial Sarcoma; Embryonal Childhood Rhabdomyosarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  2. Cixutumumab in Treating Patients With Relapsed or Refractory Solid Tumors

    ClinicalTrials.gov

    2015-03-18

    Adult Rhabdomyosarcoma; Adult Synovial Sarcoma; Childhood Hepatoblastoma; Childhood Synovial Sarcoma; Previously Treated Childhood Rhabdomyosarcoma; Recurrent Adrenocortical Carcinoma; Recurrent Adult Soft Tissue Sarcoma; Recurrent Childhood Liver Cancer; Recurrent Childhood Rhabdomyosarcoma; Recurrent Childhood Soft Tissue Sarcoma; Recurrent Ewing Sarcoma/Peripheral Primitive; Neuroectodermal Tumor; Recurrent Neuroblastoma; Recurrent Osteosarcoma; Recurrent Retinoblastoma; Recurrent Wilms Tumor and Other Childhood Kidney Tumors

  3. Laser radiation of blood in treating patients with postinfarction heart

    NASA Astrophysics Data System (ADS)

    Tashchuk, V.; Polyanskaya, O.; Chaplinsky, R.; Ilashchuk, I.; Kulyk, T.

    1999-11-01

    168 patients on the postclinical stage of treatment of acute myocardial infarction were examined by means of the use of basic antiischemic therapy and intravenous laser radiation of blood (LRB). All patients were studied with the help of transesophageal electrocardiostimulation, bicycle ergometry, echocardiography and Holter ECG monitoring in the dynamics of prolonged observation and treatment. The analysis of efficiency of the LRB has shown that the most minimal degree of myocardial ischemization was marked in patients after intravenous LRB. The patients before LRB had the greater reduction of coronary reserve. The use of LRB has given the possibility to the optimization of therapy in patients on the stage of the forming of `the postinfarction heart'.

  4. Treating Insomnia: A Review of Patient Perceptions Toward Treatment.

    PubMed

    Cheung, Janet M Y; Bartlett, Delwyn J; Armour, Carol L; Saini, Bandana

    2016-01-01

    Patient views about their treatment for insomnia often dictate outcome. This review explores the literature relating to the patients' global perceptions toward treatment for insomnia. A strategic literature search was conducted using five databases (PubMed, CINAHL, Medline, PsycINFO, and Embase). The 57 research articles included for this review were mapped out chronologically across three key stages of treatment-seeking (pretreatment appraisal, actual treatment experiences, and posttreatment evaluation). Patient perceptions played an important role across these three key stages and influenced subsequent health behaviors such as the initiation of help-seeking, treatment uptake, treatment adherence, and treatment adjustment. Patients' perceptions toward treatment were heavily grounded by their psychosocial contexts. Clinical implications and future directions for including patient-centered metrics in mainstream practice and research are discussed. PMID:26240937

  5. Medication adherence issues in patients treated for COPD

    PubMed Central

    Restrepo, Ruben D; Alvarez, Melissa T; Wittnebel, Leonard D; Sorenson, Helen; Wettstein, Richard; Vines, David L; Sikkema-Ortiz, Jennifer; Gardner, Donna D; Wilkins, Robert L

    2008-01-01

    Although medical treatment of COPD has advanced, nonadherence to medication regimens poses a significant barrier to optimal management. Underuse, overuse, and improper use continue to be the most common causes of poor adherence to therapy. An average of 40%–60% of patients with COPD adheres to the prescribed regimen and only 1 out of 10 patients with a metered dose inhaler performs all essential steps correctly. Adherence to therapy is multifactorial and involves both the patient and the primary care provider. The effect of patient instruction on inhaler adherence and rescue medication utilization in patients with COPD does not seem to parallel the good results reported in patients with asthma. While use of a combined inhaler may facilitate adherence to medications and improve efficacy, pharmacoeconomic factors may influence patient’s selection of both the device and the regimen. Patient’s health beliefs, experiences, and behaviors play a significant role in adherence to pharmacological therapy. This manuscript reviews important aspects associated with medication adherence in patients with COPD and identifies some predictors of poor adherence. PMID:18990964

  6. Quality of life of patients surgically treated for ameloblastoma

    PubMed Central

    Lawal, Hammed Sikiru; Adebola, Rafel Adetokunbo; Arotiba, Juwon Tunde; Amole, Ibiyinka Olushola; Efunkoya, Akinwale Adeyemi; Omeje, Uchenna Kelvin; Amole, Taiwo Gboluwaga; Adeoye, Joshua Biodun

    2016-01-01

    Background: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patient's quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. Patients and Methods: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7th day, 3 months, and 6 months. Results: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. Conclusion: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended. PMID:27226682

  7. [Late deficiency states in patients with a surgically treated stomach].

    PubMed

    Popova, D; Daskalov, M; Kostadinova, I

    1988-01-01

    37 patients with partial stomach resection because of peptic ulcer, performed 5 to 28 years before, were studied. In 29 patients the serum vitamin B12 and folic acid levels were determined by radioimmunoassay. In 19 patients several hematologic indices--hemoglobin, serum iron, erythrocyte morphology, proteinogram--were determined, too. The mean serum vit. B12 level was significantly lower than that of the control group of healthy persons. In 1/3 of these patients the low serum vit. B12 level was accompanied by manifested neurologic complications-myelopathy and polyneuropathy. The mean folic acid level was also low but statistically insignificantly and in patients the value was subnormal. In half of the patients a low degree hypochromic anemia was found. The role of vit. B12 deficiency in the pathogenesis of the neurologic manifestations is discussed and the determination of vit. B12 and folic acid levels is recommended in patients who had undergone gastric resection, especially after 5 years following the resection. PMID:3414095

  8. Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.

    PubMed

    Klapper, J; Lucas, C; Røsjø, Ø; Charlesworth, B

    2004-11-01

    Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset. PMID:15482352

  9. American brain tumor patients treated with BNCT in Japan

    SciTech Connect

    Laramore, G.E.; Griffin, B.R.; Spence, A.

    1995-11-01

    The purpose of this work is to establish and maintain a database for patients from the United States who have received BNCT in Japan for malignant gliomas of the brain. This database will serve as a resource for the DOE to aid in decisions relating to BNCT research in the United States, as well as assisting the design and implementation of clinical trials of BNCT for brain cancer patients in this country. The database will also serve as an information resource for patients with brain tumors and their families who are considering this form of therapy.

  10. How I treat influenza in patients with hematologic malignancies

    PubMed Central

    Casper, Corey; Englund, Janet

    2010-01-01

    The 2009 H1N1 influenza pandemic has heightened the interest of clinicians for options in the prevention and management of influenza virus infection in immunocompromised patients. Even before the emergence of the novel 2009 H1N1 strain, influenza disease was a serious complication in patients with hematologic malignancies receiving chemotherapy or undergoing hematopoietic cell transplantation. Here we review the clinical manifestations of seasonal and 2009 H1N1 influenza and discuss current diagnosis, antiviral treatment, and prophylaxis options. We also summarize infection control and vaccination strategies for patients, family members, and caregivers. PMID:20009037

  11. [Cognitive deficits in bipolar disorder].

    PubMed

    Sachs, Gabriele; Schaffer, Markus; Winklbaur, Bernadette

    2007-01-01

    Bipolar disorders are often associated with cognitive deficits which have an influence on social functioning and the course of the illness. These deficits have an impact on occupational ability and social integration. To date, specific cognitive domains have been found which characterize bipolar affective disorders. However, there is evidence of stable and lasting cognitive impairment in all phases of the disorder, including the remission phase, in the following domains: sustained attention, memory and executive functions (e.g. cognitive flexibility and problem solving). Although their cognitive deficits are comparable the deficits in patients with schizophrenia are more severe than those with bipolar disorder. Recent brain imaging findings indicate structural and functional abnormalities in the cortical and limbic networks of the brain in patients with bipolar disorder compared to healthy controls. Mood stabilizer and atypical antipsychotics may reduce cognitive deficits in certain domains (e.g. executive functions and word fluency) and may have a positive effect on quality of life and social functioning. PMID:17640495

  12. [A Patient with Cavitated Pulmonary Metastases Treated with Regorafenib].

    PubMed

    Taniguchi, Masatake; Mori, Misuzu; Sata, Naohiro; Fujii, Hirofumi

    2016-06-01

    A 61-year-old woman underwent surgical resection of rectal cancer(SI, N3, Stage IIIb)and received 12 courses of adjuvant mFOLFOX6 chemotherapy. Six months after completion of adjuvant chemotherapy, she was found to have pulmonarymetastases, and was treated with FOLFIRI plus bevacizumab. After 6 courses of chemotherapy, the pulmonarynodules showed central cavitation without anychange in size. After 6 additional courses of chemotherapy, pulmonarylesions increased in and had consolidated. She was treated with regorafenib as second-line chemotherapyfor recurrent disease. After 6 courses of regorafenib, the pulmonarynodules became cavitated. According to the RECIST criteria, the tumor response was stable disease. However, the morphologywas significantlychanged and tumor growth had been controlled for a long time. Assessment of tumor response depends not onlyon size according to the RECIST criteria, but also on the morphologic response when we assess tumor response to molecular targeted drugs. PMID:27306815

  13. Serial thyroid iodine content in hyperthyroid patients treated with radioiodine

    SciTech Connect

    Lee, G.S.; Sandler, M.P.; Patton, J.A.; Brill, A.B.

    1986-02-01

    X-ray fluorescent scanning was used to measure initial thyroidal iodine content in 64 patients diagnosed as being hyperthyroid and selected for I-131 therapy, and serially in 48 of these patients after therapy in an attempt to determine those patients that were at high risk of becoming hypothyroid. Iodine content fell rapidly after therapy, reaching a nadir at about three months. Based on the population studied, the chance of early hypothyroidism (within 12 months) is about 80% if the iodine content measured at three months is less than 2 mg. If the iodine content is greater than 2 mg, the chance is only about 14%. The serial measurement of thyroidal iodine content (with x-ray fluorescent scanning) may allow early identification of those patients at high risk of developing permanent hypothyroidism following a therapeutic dose of I-131.

  14. Administering ziconotide and monitoring patients treated with ziconotide: expert opinions.

    PubMed

    Mitchell, Alisia A; Sapienza-Crawford, Anne J; Hanley, Kari L; Lokey, Kristi J; Wells, Linda; McDowell, Gladstone C; Stanton-Hicks, Michael

    2013-09-01

    Some patients with chronic pain who are intolerant of or refractory to treatment with systemic analgesics may benefit from intrathecal therapy. Ziconotide is the first nonopioid analgesic approved by the United States Food and Drug Administration for intrathecal administration. Several randomized, double-blind, placebo-controlled clinical trials have demonstrated the efficacy and safety of ziconotide. However, the maximum recommended dosing and titration schedule provided in the prescribing information may be too aggressive for some patients, and experience has demonstrated that ziconotide is better tolerated with slower titration to a lower maximum dose. Efficacy can be assessed by an evaluation of changes in pain, functionality, and quality of life. Cognitive adverse events may be subtle; therefore, it is important that health care professionals not only monitor patients for signs and symptoms of cognitive adverse events, but also teach family members how to do the same. Careful patient assessment and monitoring can help optimize the potential benefit from treatment with ziconotide. PMID:23972874

  15. Treating Patients with High-Risk Smoldering Myeloma

    Cancer.gov

    In this phase III clinical trial, patients with smoldering myeloma classified as high risk for progression will be randomly assigned to undergo standard observation or six 4-week courses of treatment with the drug lenalidomide.

  16. Assessment of basic symptoms in schizophrenia, schizoaffective and bipolar disorders.

    PubMed

    Ricca, V; Galassi, F; La Malfa, G; Mannucci, E; Barciulli, E; Cabras, P L

    1997-01-01

    In order to evaluate the basic symptoms differences of schizophrenics, schizoaffectives and bipolar patients, a consecutive series of 72 outpatients participated in the study. According to DSM III-R criteria, 28 had a diagnosis of schizophrenia, 29 of bipolar disorder and 15 of schizoaffective disorder. The assessment of basic symptoms was performed using the Frankfurter Beschwerde-Fragebogen (FBF). Data obtained suggest that perception and thought disturbances are the most characteristic experiences of schizophrenic patients in comparison with bipolar patients. The FBF questionnaire did not highlight a characteristic basic symptoms profile of schizoaffective disorder, when compared with bipolar affective disorder and schizophrenia. PMID:9042683

  17. Objective and subjective sleep quality: Melatonin versus placebo add-on treatment in patients with schizophrenia or bipolar disorder withdrawing from long-term benzodiazepine use.

    PubMed

    Baandrup, Lone; Glenthøj, Birte Yding; Jennum, Poul Jørgen

    2016-06-30

    Benzodiazepines are frequently long-term prescribed for the treatment of patients with severe mental illness. This prescribing practice is problematic because of well-described side effects including risk of dependence. We examined the efficacy of prolonged-release melatonin on objective and subjective sleep quality during benzodiazepine discontinuation and whether sleep variables were associated with benzodiazepine withdrawal. Eligible patients included adults with a diagnosis of schizophrenia, schizoaffective disorder, or bipolar disorder and long-term use of benzodiazepines in combination with antipsychotics. All participants gradually tapered the use of benzodiazepines after randomization to add-on treatment with melatonin versus placebo. Here we report a subsample of 23 patients undergoing sleep recordings (one-night polysomnography) and 55 patients participating in subjective sleep quality ratings. Melatonin had no effect on objective sleep efficiency, but significantly improved self-reported sleep quality. Reduced benzodiazepine dosage at the 24-week follow-up was associated with a significantly decreased proportion of stage 2 sleep. These results indicate that prolonged-release melatonin has some efficacy for self-reported sleep quality after gradual benzodiazepine dose reduction, and that benzodiazepine discontinuation is not associated with rebound insomnia in medicated patients with severe mental illness. However, these findings were limited by a small sample size and a low retention rate. PMID:27107670

  18. Understanding and treating patients with alcoholic cirrhosis: an update.

    PubMed

    Addolorato, Giovanni; Russell, Marcia; Albano, Emanuele; Haber, Paul S; Wands, Jack R; Leggio, Lorenzo

    2009-07-01

    Alcoholic cirrhosis represents the terminal stage of alcoholic liver disease (ALD) and one of the main causes of death among alcohol abusers. The aim of this review was to provide an update on alcoholic cirrhosis, with an emphasis on recent findings. Increased alcohol consumption in developing countries is expected to increase cirrhosis mortality. There is a need, therefore, to develop new approaches to the prevention of ALD, including more attention to co-factors that may increase risk of ALD (i.e., obesity and diabetes, chronic HCV infection, and smoking). Furthermore, a better understanding of the pathological mechanisms on the basis of alcohol cirrhosis represents a cornerstone in order to develop new pharmacological treatments. Inflammatory and immune responses along with oxidative stress and alterations in adipokine secretion might contribute in different ways to the evolution of alcohol-induced fibrosis/cirrhosis. As of this date, patients with severe alcoholic hepatitis with a Maddrey Discriminant Factor (MDF) 32 should be offered pentoxifylline and/or corticosteroids unless contraindications exist. For ambulatory patients, S-adenosylmethionine (SAMe) may be considered in a motivated patient with nutritional support. Current studies do not support use of anti-tumor necrosis factor (TNF)-alpha antibody. Finally, achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis. In the last decades, several drugs able to increase abstinence and prevent alcohol relapse have been evaluated and some of them have obtained approval for alcohol dependence. Patients with alcoholic cirrhosis; however, are usually excluded from such treatments. A recent study demonstrated the efficacy and safety of baclofen in inducing and maintaining alcohol abstinence in cirrhotic alcohol-dependent patients with cirrhosis. All together the information available suggests the need of a multimodal approach in the clinical

  19. [Diabetics in population of patients treated by pars plana vitrectomy].

    PubMed

    Bezdésová-Bohunická, N; Skorkovská, S; Synek, S; Kanovský, R; Masková, Z; Synková, M

    2007-11-01

    The purpose of this study is to evaluate visual and anatomic outcomes following pars plana vitrectomy (PPV) for complications of diabetic retinopathy (DR), and to assess risk factors that might influence the visual outcome after successful PPV. The medical records of 35 diabetic patients of both types 1 and 2 of diabetes, who underwent vitrectomy for complications of proliferative diabetic retinopathy (PDR) between 2004 and 2005, were analyzed retrospectively. Certain preoperative systemic and ophthalmic variables, intraoperative variables and postoperative complications with negative influence on visual outcome after PPV were recorded. The postoperative follow-up time was 6 months. The collected data as well as visual outcomes after PPV were statistically analyzed. Statistically significant visual improvement was achieved in 51.4 % of the patients; visual acuity (VA) deteriorated in 25.7% of the patients and remained unchanged in 22.9 % of the patients. Preoperative median of VA was 0.0167, changed to 0.1 postoperatively and remained stable on 0.1 level during the 6 months follow-up. VA > or = 0.1 was achieved in 60 % of the patients 6 months after PPV. Some of the followed variables associated with deteriorated or unchanged postoperative VA can be considered as risk factors of an unfavorable prognosis. Evaluated risk factors include preoperative VA worse than 0.1, presence of systemic complications of DM accompanying ocular complications, postoperative occurrence of iris neovascularization and neovascular glaucoma. In conclusion, anatomically successful PPV in diabetic patients is not always followed by an improvement of VA. The optimal timing of vitrectomy is very important not only in order to obtain good visual acuity but also to maintain good visual function for long time. We suppose that an adequate control of DM, sufficient screening for DR and timely laser intervention of DR might decrease the progression of DR and onset of sight threatening complications

  20. Endotracheal Intubation in Patients Treated for Prehospital Status Epilepticus

    PubMed Central

    Miller, Joseph B.; Nicholas, Katherine S.; Varelas, Panayiotis N.; Harsh, Donna M.; Durkalski, Valerie; Silbergleit, Robert; Wang, Henry E.

    2015-01-01

    Introduction Limited data describe the frequency, timing, or indications for endotracheal intubation (ETI) in patients with status epilepticus. A better understanding of the characteristics of patients with status epilepticus requiring airway interventions could inform clinical care. We sought to characterize ETI use in patients with prehospital status epilepticus. Methods This study was a secondary analysis of the Rapid Anticonvulsant Medication Prior to Arrival Trial, a multi-center, randomized trial comparing intravenous lorazepam to intramuscular midazolam for prehospital status epilepticus treatment. Subjects received ETI in the prehospital, Emergency Department (ED), or inpatient setting at the discretion of caregivers. Results Of 1023 enrollments, 218 (21 %) received ETI. 204 (93.6 %) of the ETIs were performed in the hospital and 14 (6.4 %) in the prehospital setting. Intubated patients were older (52 vs 41 years, p < 0.001), and men underwent ETI more than women (26 vs 21 %, p = 0.047). Patients with ongoing seizures on ED arrival had a higher rate of ETI (32 vs 16 %, p < 0.001), as did those who received rescue anti-seizure medication (29 vs 20 %, p = 0.004). Mortality was higher for intubated patients (7 vs 0.4 %, p < 0.001). Most ETI (n = 133, 62 %) occurred early (prior to or within 30 min after ED arrival), and late ETI was associated with higher mortality (14 vs 3 %, p = 0.002) than early ETI. Conclusions ETI is common in patients with status epilepticus, particularly among the elderly or those with refractory seizures. Any ETI and late ETI are both associated with higher mortality. PMID:25623785

  1. Night locomotor activity and quality of sleep in quetiapine-treated patients with depression.

    PubMed

    Todder, Doron; Caliskan, Serdal; Baune, Bernhard T

    2006-12-01

    This research assesses the development of the night-activity rhythm and quality of sleep during course of treatment among patients with unipolar or bipolar depression and receiving antidepressant treatment plus quetiapine. Twenty-seven patients with major depressive episode were included into a 4-week follow-up study and compared with 27 healthy controls. Motor activity was continuously measured with an electronic wrist device (actigraphy), sleep was assessed with the Pittsburgh Sleep Quality Index, and patients were clinically assessed with the Hamilton depression score. All patients received a standard antidepressant treatment plus quetiapine. Whereas we found a rapid and maintaining improvement of subjective sleep parameters during the 4-week study, we observed a rapid improvement of some objective sleep parameters (actigraph) within the first week, but no further significant change of objective sleep parameters during the rest of the study. Another main finding of this study is that changes of subjectively and objectively assessed sleep parameters do not necessarily reflect clinical improvement of depression during the same timeline. Despite partial clinical remission, objective sleep parameters still showed significantly different patterns compared with controls. This study is the first to examine the effect of quetiapine on locomotor activity alongside with sleep in depression. As the studied patients with depression showed improvement in subjective and objective sleep parameters, quetiapine may be a promising drug for patients with depression and insomnia. Further studies need to investigate in detail the timeline of clinical remission and alterations of objective and subjective sleep parameters. PMID:17110822

  2. Use of NSAIDs in treating patients with arthritis

    PubMed Central

    2013-01-01

    Patients with rheumatic diseases, including rheumatoid arthritis and osteoarthritis, almost universally describe pain and stiffness as important contributors to reduced health-related quality of life. Of the treatment options available, NSAIDs are the most widely used agents for symptomatic treatment. NSAIDs are effective anti-inflammatory and analgesic drugs by virtue of their ability to inhibit biosynthesis of prostaglandins at the level of the cyclooxygenase enzyme. However, many of the adverse effects of NSAIDs are also related to inhibition of prostaglandin production, making their use problematic in some patient populations. For the clinician, understanding the biology of prostaglandin as it relates to gastrointestinal, renal, and cardiovascular physiology and the pharmacologic properties of specific NSAIDs is key to using these drugs safely. Of particular importance is the recognition of co-morbid conditions and concomitant drugs that may increase the risk of NSAIDs in particular patients. In patients with risk factors for NSAID toxicity, using the lowest dose of a drug with a short half-life only when it is needed is likely to be the safest treatment option. For those patients whose symptoms cannot be managed with intermittent treatment, using protective strategies is essential. PMID:24267197

  3. Clinical variables and implications of the personality on the outcome of bipolar illness: a pilot study

    PubMed Central

    Casas-Barquero, Nieves; García-López, Olga; Fernández-Argüelles, Pedro; Camacho-Laraña, Manuel

    2007-01-01

    Outcome in bipolar patients is affected by comorbidity. Comorbid personality disorders are frequent and may complicate the course of bipolar illness. This pilot study examined a series of 40 euthymic bipolar patients (DSM-IV criteria) (bipolar I disorder 31, bipolar II disorder 9) to assess the effect of clinical variables and the influence of comorbid personality on the clinical course of bipolar illness. Bipolar patients with a diagnosis of comorbid personality disorder (n = 30) were compared with “pure” bipolar patients (n = 10) with regard to demographic, clinical, and course of illness variables. Comorbid personality disorder was diagnosed in 75% of patients according to ICD-10 criteria, with obsessive-compulsive personality disorder being the most frequent type. Sixty-three per cent of subjects had more than one comorbid personality disorder. Bipolar patients with and without comorbid personality disorder showed no significant differences regarding features of the bipolar illness, although the group with comorbid personality disorder showed a younger age at onset, more depressive episodes, and longer duration of bipolar illness. In subjects with comorbid personality disorders, the number of hospitalizations correlated significantly with depressive episodes and there was an inverse correlation between age at the first episode and duration of bipolar illness. These findings, however, should be interpreted taking into account the preliminary nature of a pilot study and the contamination of the sample with too many bipolar II patients. PMID:19300559

  4. [Antidepressant-resistant depression and bipolar spectrum - diagnostic and therapeutic considerations].

    PubMed

    Rihmer, Zoltán; Gonda, Xénia; Rihmer, Annamária; Döme, Péter

    2016-01-01

    According to the results of epidemiological studies mood disorders with unipolar (major and minor depressive disorder; dysthymia) or bipolar features are among the most prevalent psychiatric disorders. These disorders with their frequent comorbidities (alcohol and/or drug use disorders, smoking, suicide, cardiovascular disorders) pose great public health challenge and cause substantial individual and familar burdens as well. Since SSRIs and other new antidepressant agents entered the market the possibilities to treat depression improved substantially but 25-35 percent of major depressives do not respond even to the second antidepressant trial but the rate of patients who are resistant after the third and fourth adequate antidepressant trial are around only 15-25 and 10 percent, respectively. Pharmacotherapy-resistant depression is a multicausal phenomenon. Along with its well-known risk-factors investigations of the past decade have revealed that unrecognised or hidden (subsyndromal or subthreshold) bipolarity is one of the most frequent causes of treatment resistance. In the case of bipolar depression (either as a part of syndromal bipolar I or II disorder or a subsyndromal manifestation) antidepressant monotherapy should be avoided and, instead of it, the administration of a mood stabilizer (primarily lithium and lamotrigine) or some atypical antipsychotics (preferably quetiapine) are recommended. If antidepressant is inevitably necessary in bipolar depression, we should use it always in combination with mood stabilizers or atypical antipsychotics. PMID:27244871

  5. [Adherence and fidelity in patients treated with intragastric balloon].

    PubMed

    Mazure, R A; Cancer, E; Martínez Olmos, M A; De Castro, M L; Abilés, V; Abilés, J; Bretón, I; Álvarez, V; Peláez, N; Culebras, J M

    2014-01-01

    A correct treatment of obesity needs a program of habits modification regardless of the selected technique, especially if it is minimally invasive as the intragastric balloon (BIG). The adherence of the obese patients with regard to recommended drugs measures to medium- and long-term is less than 50%. Given that the results obtained using the technique of gastric balloon must be seen influenced by adherence to the modification of habits program and its fulfillment, we reviewed series published in attention to the program proposed with the BIG. The series published to date provide few details about the used Therapeutic Programs as well as the adherence of patients to them, and even less concerning the Monitoring Plan and the loyalty of the patient can be seen. We conclude the convenience to agree on a follow-up strategy, at least the 6 months during which the BIG remain in the stomach. PMID:24483961

  6. Blood transfusion: implications of treating a Jehovah's Witness patient.

    PubMed

    Effa-Heap, Gladys

    Jehovah's Witnesses believe that an individual's life is contained within blood, and that accepting transfusion of blood and blood products is sinful. The administration of blood to a Jehovah's Witness who has refused to accept transfusion may lead to criminal or civil proceedings. From an ethical viewpoint, if a rational adult who has been fully apprised of the consequences of not receiving this treatment persists in a refusal, the decision should be respected. Medical and nursing staff faced with such a problem should explore fully with the patient any transfusion alternatives that the patient might find acceptable, such as cell salvage, volume expanders, antifibrinolytics and pharmaceutical options, such as erythropoietin. This article examines the legal and consent issues around blood transfusion in Jehovah's Witness patients and their implications for medical and surgical management. PMID:19223803

  7. Treating COPD in Older and Oldest Old Patients.

    PubMed

    Corsonello, Andrea; Scarlata, Simone; Pedone, Claudio; Bustacchini, Silvia; Fusco, Sergio; Zito, Anna; Incalzi, Raffaele Antonelli

    2015-01-01

    The treatment of older and oldest old patients with COPD poses several problems and should be tailored to specific outcomes, such as physical functioning. Indeed, impaired homeostatic mechanisms, deteriorated physiological systems, and limited functional reserve mainly contribute to this complex scenario. Therefore, we reviewed the main difficulties in managing therapy for these patients and possible remedies. Inhaled long acting betaagonists (LABA) and anticholinergics (LAMA) are the mainstay of therapy in stable COPD, but it should be considered that pharmacological response and safety profile may vary significantly in older patients with multimorbidity. Their association with inhaled corticosteroids is recommended only for patients with severe or very severe airflow limitation or with frequent exacerbations despite bronchodilator treatment. In hypoxemic patients, long-term oxygen therapy (LTOT) may improve not only general comfort and exercise tolerance, but also cognitive functions and sleep. Nonpharmacological interventions, including education, physical exercise, nutritional support, pulmonary rehabilitation and telemonitoring can importantly contribute to improve outcomes. Older patients with COPD should be systematically evaluated for the presence of risk factors for non-adherence, and the inhaler device should be chosen very carefully. Comorbidities, such as cardiovascular diseases, chronic kidney disease, osteoporosis, obesity, cognitive, visual and auditory impairment, may significantly affect treatment choices and should be scrutinized. Palliative care is of paramount importance in end-stage COPD. Finally, treatment of COPD exacerbations has been also reviewed. Therapeutic decisions should be founded on a careful assessment of cognitive and functional status, comorbidity, polypharmacy, and agerelated changes in pharmacokinetics and pharmacodynamics in order to minimize adverse drug events, drug-drug or drug-disease interactions, and non-adherence to

  8. Decrease in blood histamine in drug-treated parkinsonian patients.

    PubMed

    Coelho, M H; Silva, I J; Azevedo, M S; Manso, C F

    1991-04-01

    Blood histamine and serum histaminase activity were determined in a group of patients with Parkinson disease (PD) and in a group of healthy controls. Untreated PD patients present significantly higher blood histamine than normal controls. Therapy with L-dopa + cardidopa results in a significant decrease in blood histamine. This decrease becomes more accentuated when anticholinergics are added to this therapy. No significant changes were detected in plasma histaminase. The authors suggest, as a hypothesis, that the CNS contributes to blood histamine concentration and that its rise is the result of increased neuronal destruction. PMID:1910360

  9. Patient Report: Autism Spectrum Disorder Treated With Camel Milk

    PubMed Central

    2013-01-01

    This patient report is about my son, who was diagnosed with autism spectrum disorder (ASD) at 3 years of age, and the effects I observed when he began drinking camel milk daily. Beginning at age 9, he drank one half cup of raw camel milk a day and experienced overnight an improvement in his symptoms. His continued regular consumption of camel milk was associated with sustained symptom improvements for 6 consecutive years (2007-2013). This patient report is a road map of my navigations, consultations with experts and autism care providers, and the apparent effect of camel milk on autism spectrum disorder (ASD). PMID:24349886

  10. White matter microstructure alterations in bipolar disorder

    PubMed Central

    Bellani, Marcella; Perlini, Cinzia; Ferro, Adele; Cerruti, Stefania; Rambaldelli, Gianluca; Isola, Miriam; Cerini, Roberto; Dusi, Nicola; Andreone, Nicola; Balestrieri, Matteo; Mucelli, Roberto Pozzi; Tansella, Michele; Brambilla, Paolo

    2012-01-01

    Summary Genetic, neuropathological and magnetic resonance imaging findings support the presence of diffuse white matter cytoarchitectural disruption in bipolar disorder. In this study, diffusion-weighted imaging (DWI) was applied to study cortical white matter microstructure organisation in 24 patients with DSM-IV bipolar disorder and 35 matched normal controls. DWI images were obtained using a 1.5 Tesla scanner and apparent diffusion coefficient (ADC) values were determined over regions of interest placed, bilaterally, in the frontal, temporal, parietal, and occipital white matter. Significantly increased ADC values were found in bipolar patients with respect to normal controls in the right temporal lobe, left parietal lobe and bilateral occipital lobes. ADC values did not associate significantly with age or with clinical variables (p>0.05). Diffuse cortical white matter alterations on DWI in bipolar disorder denote widespread disruption of white matter integrity and may be due to altered myelination and/or axonal integrity. PMID:22687164

  11. [Bullous dermatosis at distant sites in patients treated with heparin].

    PubMed

    Castellanos-González, María; Velasco-Rodríguez, Diego; Mancebo Plaza, Ana Belén

    2016-05-01

    Since Perrinaud in 2006 first described three patients with hemorrhagic bullae in relation to the use of heparins, numerous cases have been published. Currently, this entity has been established as a clearly defined pathology. We review all reported cases, diagnostic features and features that differentiate it from other skin manifestations caused by heparin having a worse prognosis and requiring a precise identification. PMID:26701130

  12. CNS Involvement in AML Patient Treated with 5-Azacytidine

    PubMed Central

    Vasilatou, Diamantina; Papageorgiou, Sotirios; Bazani, Efthymia; Prasouli, Athina; Economopoulou, Christina; Roumpakis, Christoforos; Karakitsos, Petros; Dimitriadis, George; Pappa, Vasiliki

    2014-01-01

    Central nervous system (CNS) involvement in acute myeloid leukemia (AML) is a rare complication of the disease and is associated with poor prognosis. Sometimes the clinical presentation can be unspecific and the diagnosis can be very challenging. Here we report a case of CNS infiltration in a patient suffering from AML who presented with normal complete blood count and altered mental status. PMID:25197583

  13. CNS Involvement in AML Patient Treated with 5-Azacytidine.

    PubMed

    Vasilatou, Diamantina; Papageorgiou, Sotirios; Bazani, Efthymia; Prasouli, Athina; Economopoulou, Christina; Roumpakis, Christoforos; Karakitsos, Petros; Dimitriadis, George; Pappa, Vasiliki

    2014-01-01

    Central nervous system (CNS) involvement in acute myeloid leukemia (AML) is a rare complication of the disease and is associated with poor prognosis. Sometimes the clinical presentation can be unspecific and the diagnosis can be very challenging. Here we report a case of CNS infiltration in a patient suffering from AML who presented with normal complete blood count and altered mental status. PMID:25197583

  14. Primary Care Providers' Views regarding Assessing and Treating Suicidal Patients

    ERIC Educational Resources Information Center

    Graham, Ryan D.; Rudd, M. David; Bryan, Craig J.

    2011-01-01

    Primary care providers (PCPs) usually do not explore patient suicidality during routine visits. Factors that predict PCP attitudes toward the assessment and treatment of suicidality were examined via an online survey of 195 practicing PCPs affiliated with medical schools in the United States. PCPs who perceived themselves as competent to work with…

  15. Treating Families of Demented Patients: Two Group Models.

    ERIC Educational Resources Information Center

    Kramer, Joel

    The prevalence of dementias in the elderly is steadily increasing. While caring for a dementing patient at home, families are subject to tremendous physical stresses and emotional reactions such as guilt, anger, grief, role confusion, depression, resentment, and loneliness. Two group treatment models addressing the mental health needs of…

  16. Exercise in Treating Hypertension: Tailoring Therapies for Active Patients.

    ERIC Educational Resources Information Center

    Chintanadilok, Jirayos

    2002-01-01

    Exercise can be definitive therapy for some, and adjunctive therapy for many, people with hypertension, though people with secondary hypertension may not derive as much benefit. Low-to- moderate-intensity aerobic exercise can help with mild hypertension and reduce drug dosages in more severe cases. For active patients requiring medication,…

  17. Treating Hispanic patients for type 2 diabetes mellitus: special considerations.

    PubMed

    Freeman, Jeffrey S

    2008-05-01

    The number of Hispanic people in the United States with diagnosed diabetes mellitus is projected to increase by 107% by 2020. The author presents the case of a 62-year-old obese Hispanic man, with newly diagnosed type 2 diabetes mellitus (T2DM), diabetic peripheral neuropathy, background retinopathy, and diabetic nephropathy. The patient also had diagnosed hypertension, peripheral vascular disease, and hyperlipidemia. The treatment plan for this patient included the following medications: pioglitazone hydrochloride (a thiazolidinedione, 30 mg/d); irbesartan (an angiotensin receptor blocker, 150 mg/d titrated to 300 mg/d); hydrochlorothiazide (an antikaliuretic agent, 12.5 mg/d); and aspirin (325 mg/d). Sitagliptin phosphate (a dipeptidyl peptidase IV inhibitor, 50 mg/d) was added to the treatment regimen to improve glycemic control. Simvastatin (20 mg/d) and niacin (1 g/d) were used for lipid management. Therapy also included a low-protein diet and walking program. At 6-month follow-up, the patient showed substantial improvement in his glycosylated hemoglobin level, lipid profile, blood pressure, creatinine clearance rate, and urine albumin level. There were also improvements in his peripheral vascular disease and diabetic peripheral neuropathy. Furthermore, the patient demonstrated encouraging progress in diet and lifestyle modification and in mental attitude. PMID:18519840

  18. Gerontology & Policies for Not Treating Terminally Ill Patients.

    ERIC Educational Resources Information Center

    Jarrett, William H.

    Proposals have been developed to clarify physician responsibility in withholding treatment to terminally ill patients. These proposals seek to provide a legal shield against malpractice proceedings and to reduce confusion over how to resolve high medical costs through standardizing procedures for withholding treatment. When first published,…

  19. Persistence with osteoporosis medication among newly-treated osteoporotic patients.

    PubMed

    van Boven, Job F M; de Boer, Pieter T; Postma, Maarten J; Vegter, Stefan

    2013-09-01

    Low persistence with osteoporosis medication is associated with higher fracture risk. Previous studies estimated that 1-year persistence with osteoporosis medication is low. Our aim was to study persistence with osteoporosis medication among patients with long-term follow-up (to 5 years). The InterAction Database (IADB) was used to analyze persistence of 8610 Dutch patients initiating osteoporosis drugs between 2003 and 2011. Drugs under study were alendronate, risedronate, ibandronate, etidronate, raloxifene and strontium ranelate. Cumulative persistence rates were calculated after different time frames (3 months-5 years) using survival analysis. Multivariate Cox proportional hazard analyses were used to identify determinants of non-persistence. Furthermore, switching rates of persistent patients who initiated bisphosphonate therapy were analyzed. Persistence with osteoporosis therapy was 70.7 % (95 % CI, 69.7-71.7), 58.5 % (95 % CI, 57.4-59.6 %), 25.3 % (95 % CI, 24.1-26.5) after 6 months, 1 and 5 years, respectively. Determinants associated with higher risk to non-persistence within the first year were daily dosing regimen [HR, 1.76 (95 % CI, 1.46-2.14)], age <60 years [HR, 1.26 (95 % CI, 1.19-1.34)] and use of glucocorticoids [HR, 1.16 (95 % CI, 1.07-1.26)]. Monthly dosing schedule and use of generic brands of alendronate did not show a significant association with non-persistence. Approximately 4.0 % of patients initiating therapy with weekly alendronate or weekly risedronate switched therapy. Persistence with osteoporosis medication is low. Because low persistence is strongly associated with higher fracture risk, interventions to improve persistence are recommended. This study identified several patient groups in whom such interventions may be most relevant. PMID:23575910

  20. Long term evolution of patients treated in a TIA unit

    PubMed Central

    2013-01-01

    Background Transient ischemic attacks (TIA) entail a high risk of stroke recurrence, which depends on the etiology. New organizational models have been created, but there is not much information about the long-term evolution of patients managed according to these premises. Our aim is to refer the follow-up of patients attended according to our model of TIA Unit. Methods TIA Unit is located in the Emergency Department and staffed by vascular neurologists. Patients admitted during the Neurology night shift stayed in such Unit <48h with complete etiological study. Preventive treatment is instituted in patients discharged to a high resolution Neurology consult, in order to review in <2 weeks and subsequent follow-up. Results During a year 161 patients were attended, being admitted to the hospital 8.6%. A total of 1470 hospital days were avoided. Recurrence at 90 days was of 0.6%. Mean follow-up was 18.14 ± 8.02 months (0–34), total recurrence 6.2% (70% cardioembolic strokes). There were no complications derived from treatment. Cardiological events were recorded in 10.6%, neoplastic in 5%, cognitive impairment in 11%. There were 3 deaths unrelated nor to the stroke or its treatment. Conclusions This model allows an early diagnosis and treatment of TIA, preventing recurrences of stroke in a long term. It detects atherothrombotic strokes, most of them admitted to the hospital, and it shows a greater difficulty for detecting all cardioembolic strokes. TIA Unit appeared to be safe in using anticoagulation therapy, as the follow-up shows. It shows the same quality of management than hospital admission, with a significant saving in hospital stays. PMID:23635082

  1. Mutation/SNP analysis in EF-hand calcium binding domain of mitochondrial Ca[Formula: see text] uptake 1 gene in bipolar disorder patients.

    PubMed

    Safari, Roghaiyeh; Salimi, Reza; Tunca, Zeliha; Ozerdem, Aysegul; Ceylan, Deniz; Sakizli, Meral

    2016-06-01

    Calcium signaling is important for synaptic plasticity, generation of brain rhythms, regulating neuronal excitability, data processing and cognition. Impairment in calcium homeostasis contributed to the development of psychiatric disorders such as bipolar disorder (BP). MCU is the most important calcium transporter in mitochondria inner membrane responsible for influx of Ca[Formula: see text]. MICU1 is linked with MCU and has two canonical EF hands that are vital for its activity and regulates MCU-mediated Ca[Formula: see text] influx. In the current study, we aimed to investigate the role of genetic alteration of EF hand calcium binding motifs of MICU1 on the development of BP. We examined patients with BP, first degree relatives of these patients and healthy volunteers for mutations and polymorphisms in EF hand calcium binding motifs of MICU1. The result showed no SNP/mutation in BP patients, in healthy subjects and in first degree relatives. Additionally, alignment of the EF hand calcium binding regions among species (Gallus-gallus, Canis-lupus-familiaris, Bos-taurus, Mus-musculus, Rattus-norvegicus, Pan-troglodytes, Homosapiens and Danio-rerio) showed exactly the same amino acids (DLNGDGEVDMEE and DCDGNGELSNKE) except in one of the calcium binding domain of Danio-rerio that there was only one difference; leucine instead of Methionine. Our results showed that the SNP on EF-hand Ca[Formula: see text] binding domains of MICU1 gene had no effect in phenotypic characters of BP patients. PMID:27297032

  2. Chemotherapy Plus Sargramostim in Treating Patients With Refractory Myeloid Cancer

    ClinicalTrials.gov

    2013-01-08

    Accelerated Phase Chronic Myelogenous Leukemia; Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; Chronic Phase Chronic Myelogenous Leukemia; Paroxysmal Nocturnal Hemoglobinuria; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia; Refractory Anemia With Ringed Sideroblasts; Relapsing Chronic Myelogenous Leukemia; Thrombocytopenia; Untreated Adult Acute Myeloid Leukemia

  3. Rasburicase and Allopurinol in Treating Patients With Hematologic Malignancies

    ClinicalTrials.gov

    2015-05-28

    Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Del(5q); Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(15;17)(q22;q12); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Blastic Phase Chronic Myelogenous Leukemia; Contiguous Stage II Adult Burkitt Lymphoma; de Novo Myelodysplastic Syndromes; Noncontiguous Stage II Adult Burkitt Lymphoma; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Recurrent Adult Burkitt Lymphoma; Stage I Adult Burkitt Lymphoma; Stage III Adult Burkitt Lymphoma; Stage IV Adult Burkitt Lymphoma; Untreated Adult Acute Lymphoblastic Leukemia; Untreated Adult Acute Myeloid Leukemia

  4. Offspring of patients treated for unilateral Wilms' tumor in childhood

    SciTech Connect

    Green, D.M.; Fine, W.E.; Li, F.P.

    1982-01-01

    Twenty-seven women and the wives of nine men who survived unilateral Wilms' tumor in childhood had a total of 59 live born offspring. Among the 33 infants born to women who had received orthovoltage abdominal irradiation, ten weighed less than 2500 g at birth and three died during the perinatal period. In addition, one term infant of normal weight died of complications of a breech delivery. Only one of 26 infants born to the wives of Wilms' tumor patients and unirradiated female patients weighed less than 2500 g at birth and none died. The frequency of congenital malformations and spontaneous abortions in this series was not increased, and no offspring has developed cancer. The findings suggest that the risk of Wilms' tumor is low among progeny of survivors of nonfamilial, unilateral lesions. Damage from abdominal irradiation given to girls with Wilms' tumor may predispose them to the subsequent delivery of low birthweight children.

  5. Being ready to treat Ebola virus disease patients.

    PubMed

    Brett-Major, David M; Jacob, Shevin T; Jacquerioz, Frederique A; Risi, George F; Fischer, William A; Kato, Yasuyuki; Houlihan, Catherine F; Crozier, Ian; Bosa, Henry Kyobe; Lawler, James V; Adachi, Takuya; Hurley, Sara K; Berry, Louise E; Carlson, John C; Button, Thomas C; McLellan, Susan L; Shea, Barbara J; Kuniyoshi, Gary G; Ferri, Mauricio; Murthy, Srinivas G; Petrosillo, Nicola; Lamontagne, Francois; Porembka, David T; Schieffelin, John S; Rubinson, Lewis; O'Dempsey, Tim; Donovan, Suzanne M; Bausch, Daniel G; Fowler, Robert A; Fletcher, Thomas E

    2015-02-01

    As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD. PMID:25510724

  6. Being Ready to Treat Ebola Virus Disease Patients

    PubMed Central

    Brett-Major, David M.; Jacob, Shevin T.; Jacquerioz, Frederique A.; Risi, George F.; Fischer, William A.; Kato, Yasuyuki; Houlihan, Catherine F.; Crozier, Ian; Bosa, Henry Kyobe; Lawler, James V.; Adachi, Takuya; Hurley, Sara K.; Berry, Louise E.; Carlson, John C.; Button, Thomas. C.; McLellan, Susan L.; Shea, Barbara J.; Kuniyoshi, Gary G.; Ferri, Mauricio; Murthy, Srinivas G.; Petrosillo, Nicola; Lamontagne, Francois; Porembka, David T.; Schieffelin, John S.; Rubinson, Lewis; O'Dempsey, Tim; Donovan, Suzanne M.; Bausch, Daniel G.; Fowler, Robert A.; Fletcher, Thomas E.

    2015-01-01

    As the outbreak of Ebola virus disease (EVD) in West Africa continues, clinical preparedness is needed in countries at risk for EVD (e.g., United States) and more fully equipped and supported clinical teams in those countries with epidemic spread of EVD in Africa. Clinical staff must approach the patient with a very deliberate focus on providing effective care while assuring personal safety. To do this, both individual health care providers and health systems must improve EVD care. Although formal guidance toward these goals exists from the World Health Organization, Medecin Sans Frontières, the Centers for Disease Control and Prevention, and other groups, some of the most critical lessons come from personal experience. In this narrative, clinicians deployed by the World Health Organization into a wide range of clinical settings in West Africa distill key, practical considerations for working safely and effectively with patients with EVD. PMID:25510724

  7. Acute chest pain in a patient treated with capecitabine.

    PubMed

    Camaro, C; Danse, P W; Bosker, H A

    2009-08-01

    A 61-year-old male with a history of metastatic colorectal cancer was referred to our hospital for primary coronary intervention because of acute ST-elevation myocardial infarction. Coronary angiography, however, revealed no significant stenoses. When asked, the patient revealed that capecitabine (Xeloda(R)) was started by his oncologist one day before admission. It is known that this oral 5-FU analogue drug, used in metastatic colorectal cancer, can cause coronary artery spasms. The main treatment of capecitabine-induced vasospasm is discontinuation of the drug. Indeed, after cessation of the drug the patient remained free of symptoms and the ECG abnormalities normalised. (Neth Heart J 2009;17:288-91.). PMID:19789697

  8. Oral isotretinoin. How can we treat difficult acne patients?

    PubMed

    Leyden, J J

    1997-01-01

    Isotretinoin (Roaccutane/Accutane) therapy (120 mg/kg) normally results in complete clearing of nodulocystic acne followed by prolonged remission, and many patients remain free of disease. Four groups of patients respond poorly or have a high rate of relapse. Preteens and young teenagers show a high rate of relapse and several courses of treatment are usually needed; 14 of 20 under the age of 12 years, 21 of 47 aged 12-14 and 23 of 66 aged 14-16 relapsed within 1 year. Individuals with linear lesions consisting of undermining tracks of follicular epithelium often show only a partial response. These individuals typically have a history of other 'sinus track' disease such as pilonidial sinus and hidradenitis, either themselves or other family members. Hemorrhagic or crusted lesions can be exacerbated by full doses of isotretinoin and patients develop pyrogenic-granuloma-type lesions and even acne-fulminans-like eruptions. Women with adrenal or ovarian syndrome associated with elevated androgens commonly relapse with 6-12 months after isotretinoin therapy. PMID:9310743

  9. Options for treating postherpetic neuralgia in the medically complicated patient

    PubMed Central

    Bruckenthal, Patricia; Barkin, Robert L

    2013-01-01

    Patients with postherpetic neuralgia (PHN) are often of advanced age or immunocompromised and likely to have ≥1 comorbid medical condition for which they receive ≥1 medication (polypharmacy). Comorbidities affecting renal or hepatic function can alter pharmacokinetics, thereby impacting the efficacy or tolerability of PHN analgesic therapies. Cardiovascular, cerebrovascular, or psychiatric comorbidities may increase patient vulnerability to potential adverse events associated with some PHN analgesic therapies. Because PHN is a localized condition, localized therapy with a topical analgesic (lidocaine patch 5% and capsaicin 8% patch or cream) may provide adequate efficacy while mitigating the risk of systemic adverse events compared with oral analgesics (eg, tricyclic antidepressants, anticonvulsants, opioids). However, combined therapy with a topical and an oral analgesic or with >1 oral analgesic may be needed for optimal pain management in some patients. This review summarizes how comorbidities and concomitant medications should be taken into account when selecting among available pharmacotherapies for PHN and provides recommendations for the selection of therapies that will provide analgesia while minimizing the risk of adverse events. PMID:23990726

  10. Is impulsivity a common trait in bipolar and unipolar disorders?

    PubMed Central

    Henna, Elaine; Hatch, John P; Nicoletti, Mark; Swann, Alan C; Zunta-Soares, Giovana; Soares, Jair C

    2012-01-01

    Objectives Impulsivity is increased in bipolar and unipolar disorders during episodes and is associated with substance abuse disorders and suicide risk. Impulsivity between episodes predisposes to relapses and poor therapeutic compliance. However, there is little information about impulsivity during euthymia in mood disorders. We sought to investigate trait impulsivity in euthymic bipolar and unipolar disorder patients, comparing them to healthy individuals and unaffected relatives of bipolar disorder patients. Methods Impulsivity was evaluated by the Barratt Impulsiveness Scale (BIS-11A) in 54 bipolar disorder patients, 25 unipolar disorder patients, 136 healthy volunteers, and 14 unaffected relatives. The BIS-11A mean scores for all four groups were compared through the Games–Howell test for all possible pairwise combinations. Additionally, we compared impulsivity in bipolar and unipolar disorder patients with and without history of suicide attempt and substance abuse disorder. Results Bipolar and unipolar disorder patients scored significantly higher than the healthy controls and unaffected relatives on all measures of the BIS-11A except for attentional impulsivity. On the attentional impulsivity measures there were no differences among the unaffected relatives and the bipolar and unipolar disorder groups, but all three of these groups scored higher than the healthy participant group. There was no difference in impulsivity between bipolar and unipolar disorder subjects with and without suicide attempt. However, impulsivity was higher among bipolar and unipolar disorder subjects with past substance use disorder compared to patients without such a history. Conclusions Questionnaire-measured impulsivity appears to be relatively independent of mood state in bipolar and unipolar disorder patients; it remains elevated in euthymia and is higher in individuals with past substance abuse. Elevated attentional and lower non-planning impulsivity in unaffected relatives of

  11. Identification of multidrug resistance in previously treated tuberculosis patients: a mixed methods study in Cambodia

    PubMed Central

    Royce, S; Khann, S; Yadav, RP; Mao, ET; Cattamanchi, A; Sam, S; Handley, MA

    2014-01-01

    SUMMARY Setting Previously treated tuberculosis (TB) patients are a priority for drug susceptibility testing (DST) to identify cases with multidrug resistance (MDR). In Cambodia, a recent study found that only one-third of smear-positive previously treated patients had DST results. Objective To quantify the gaps in detecting MDR in previously treated TB patients in Cambodia, and describe health workers’ perspectives on barriers, facilitators and potential interventions. Design We analyzed case notifications in Cambodia (2004–2012) and conducted semi-structured interviews with key stakeholders Results The proportion of previously treated notifications varied significantly across provinces 2010–12, in the context of longer term trends of decreasing relapse and increasing “other” retreatment notifications. Correct classification of patients’ TB treatment history and ensuring specimens from previously-treated patients are collected and reach the laboratory could nearly double the number of detected MDR-TB cases. Identified barriers include patients’ reluctance to disclose and staff difficulty eliciting treatment history, partly due to availability of streptomycin only in hospitals. Facilitators include trained health workers, collection of sputum for DST even if previously treated patients are not taking streptomycin, streamlining sputum transportation and promptly reporting results. Conclusion Improved monitoring, supportive supervision, and correctly classifying previously treated patients are essential for improving detection of MDR-TB. PMID:25299861

  12. Treatment Guidelines for Children and Adolescents with Bipolar Disorder

    ERIC Educational Resources Information Center

    Kowatch, Robert A.; Fristad, Mary; Birmaher, Boris; Wagner, Karen Dineen; Findling, Robert L.; Hellander, Martha

    2005-01-01

    Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute…

  13. Radiation pneumonitis in breast cancer patients treated with conservative surgery and radiation therapy

    SciTech Connect

    Lingos, T.I.; Recht, A.; Vicini, F.; Abner, A.; Silver, B.; Harris, J.R. )

    1991-07-01

    The likelihood of radiation pneumonitis and factors associated with its development in breast cancer patients treated with conservative surgery and radiation therapy have not been well established. To assess these, the authors retrospectively reviewed 1624 patients treated between 1968 and 1985. Median follow-up for patients without local or distant failure was 77 months. Patients were treated with either tangential fields alone (n = 508) or tangents with a third field to the supraclavicular (SC) or SC-axillary (AX) region (n = 1116). Lung volume treated in the tangential fields was generally limited by keeping the perpendicular distance (demagnified) at the isocenter from the deep field edges to the posterior chest wall (CLD) to 3 cm or less. Seventeen patients with radiation pneumonitis were identified (1.0%). Radiation pneumonitis was diagnosed when patients presented with cough (15/17, 88%), fever (9/17, 53%), and/or dyspnea (6/17, 35%) and radiographic changes (17/17) following completion of RT. Radiographic infiltrates corresponded to treatment portals in all patients, and in 12 of the 17 patients, returned to baseline within 1-12 months. Five patients had permanent scarring on chest X ray. No patient had late or persistent pulmonary symptoms. The incidence of radiation pneumonitis was correlated with the combined use of chemotherapy (CT) and a third field. Three percent (11/328) of patients treated with a 3-field technique who received chemotherapy developed radiation pneumonitis compared to 0.5% (6 of 1296) for all other patients (p = 0.0001). When patients treated with a 3-field technique received chemotherapy concurrently with radiation therapy, the incidence of radiation pneumonitis was 8.8% (8/92) compared with 1.3% (3/236) for those who received sequential chemotherapy and radiation therapy (p = 0.002).

  14. Autoantibody formation in patients with rheumatoid arthritis treated with anti-TNFα

    PubMed Central

    Eriksson, C; Engstrand, S; Sundqvist, K; Rantapaa-Dahlqvis..., S

    2005-01-01

    Background: Research on autoantibody formation in patients treated with TNFα inhibitors has produced contradictory results. Objective: To study the prevalence of autoantibodies in patients with rheumatoid arthritis treated with the TNFα inhibitor infliximab. Methods: 53 patients (48 female, 11 male) treated with infliximab for rheumatoid arthritis were followed for autoantibody production before treatment and after 14, 30, and 54 weeks. Six patients treated with etanercept were studied for comparison. The analyses included antibodies against nuclear antigens (ANA), extractable nuclear antigens, double stranded (ds)DNA (by ELISA, IIF on Crithidia luciliae for IgM and IgG, and Farr assay), nucleosomes, cardiolipin, smooth muscle, mitochondria, proteinase 3, and myeloperoxidase antigens. Results: The number of patients treated with infliximab who developed antibodies against dsDNA of both IgG and IgM class (tested by IIF) increased significantly. The prevalence of patients positive for IgG class increased to 66% at 30 weeks and 45% at 54 weeks, and of IgM class to 85% and 70%, respectively. The titre and number of patients expressing antibodies against nucleosomes and ANA also increased significantly. The number of rheumatoid factor or anticardiolipin positive patients was stable and there was no increase in antibodies against the other antigens. A lupus-like syndrome was seen in one patient. No patient treated with etanercept developed any of these autoantibodies. Conclusions: Patients treated with infliximab may develop anti-dsDNA antibodies of both IgM and IgG class, anti-nucleosome antibodies, and ANA, with a gradual increase until 30 weeks. PMID:15297281

  15. Long-Term Outcomes of Patients With Spinal Cord Gliomas Treated by Modern Conformal Radiation Techniques

    SciTech Connect

    Kahn, Jenna; Loeffler, Jay Steven; Niemierko, Andrzej

    2011-09-01

    Purpose: This study retrospectively examines the long-term therapeutic outcomes of 32 patients with primary spinal cord gliomas at Massachusetts General Hospital between 1991 and 2005 treated by either photon intensity-modulated radiotherapy or conformal proton radiotherapy. Methods and Materials: Individual patient tumor types included 14 ependymomas, 17 astrocytomas, and one oligodendroglioma. Twenty-two patients were treated with photon beam radiation therapy, and 10 patients were treated with proton beam therapy. The overall survival and time to progression were analyzed. Average radiation dose for patients was 51 Gy in 1.8 median daily fractions over 29 treatments. Results: For all 32 patients, the overall 5-year survival was 65% and the progression-free survival was 61%, respectively. Overall survival was significantly worse for patients more than 55 years of age (p = 0.02). Ependymoma patients had significantly longer survival times than astrocytoma patients (p = 0.05). Patients who had undergone a biopsy developed worse outcomes then those with a resection (p = 0.05). With the caveat of a limited number of patients, the multivariate model seems to suggest improved overall survival for younger patients (<54 years of age), ependymoma histology, and photon vs. proton treatment. Conclusion: For patients with spinal cord gliomas, significant factors associated with patient outcome include tumor pathology, age, extent of surgery, and treatment.

  16. Clinical usefulness of the screen for cognitive impairment in psychiatry (SCIP-S) scale in patients with type I bipolar disorder

    PubMed Central

    Guilera, Georgina; Pino, Oscar; Gómez-Benito, Juana; Rojo, J Emilio; Vieta, Eduard; Tabarés-Seisdedos, Rafael; Segarra, Nuria; Martínez-Arán, Anabel; Franco, Manuel; Cuesta, Manuel J; Crespo-Facorro, Benedicto; Bernardo, Miguel; Purdon, Scot E; Díez, Teresa; Rejas, Javier

    2009-01-01

    Background The relevance of persistent cognitive deficits to the pathogenesis and prognosis of bipolar disorders (BD) is understudied, and its translation into clinical practice has been limited by the absence of brief methods assessing cognitive status in Psychiatry. This investigation assessed the psychometric properties of the Spanish version of the Screen for Cognitive Impairment in Psychiatry (SCIP-S) for the detection of cognitive impairment in BD. Methods After short training, psychiatrists at 40 outpatient clinics administered the SCIP three times over two weeks to a total of 76 consecutive type I BD admissions. Experienced psychologists also administered a comprehensive battery of standard neuropsychological instruments to clinical sample and 45 healthy control subjects. Results Feasibility was supported by a brief administration time (approximately 15 minutes) and minimal scoring errors. The reliability of the SCIP was confirmed by good equivalence of forms, acceptable stability (ICC range 0.59 to 0.87) and adequate internal consistency (Chronbach's alpha of 0.74). Construct validity was granted by extraction of a single factor (accounting 52% of the variance), acceptable correlations with conventional neuropsychological instruments, and a clear differentiation between bipolar I and normal samples. Efficiency was also provided by the adequate sensitivity and specificity. Limitations The sample size is not very large. The SCIP and the neurocognitive battery do not cover all potentially relevant cognitive domains. Also, sensitivity to change remains unexplored. Conclusion With minimal training, physicians obtained a reliable and valid estimate of cognitive impairment in approximately 15 minutes from an application of the SCIP to type I BD patients. PMID:19338661

  17. Technetium-99m red blood cell labeling in patients treated with doxorubicin

    SciTech Connect

    Ballinger, J.R.; Gerson, B.; Gulenchyn, K.Y.; Ruddy, T.D.; Davies, R.A.

    1988-03-01

    Radionuclide angiography is useful in monitoring cardiotoxicity of doxorubicin, but in vivo RBC labeling in these patients is believed to be poorer than that in general patients. The left ventricle-to-background activity ratio (R) was not significantly lower in patients treated with doxorubicin (3.24 +/- 1.15, N = 13) than in control patients (3.89 +/- 1.60, N = 14). With both modified in vivo and in vitro labeling, R was significantly improved in patients treated with doxorubicin (4.37 +/- 0.91, N = 8, and 4.37 +/- 1.22, N = 13, respectively). However, with the modified in vivo method, labeling efficiency remained a function of hematocrit, whereas the in vitro method removed this dependency. Both modified in vivo and in vitro labeling result in improved image quality over in vivo labeling in patients treated with doxorubicin, and the choice of method can be based on other factors.

  18. Basal cell carcinomas in elderly patients treated by cryotherapy.

    PubMed

    Chiriac, Anca; Mihaila, Doina; Foia, Liliana; Solovan, Caius

    2013-01-01

    Basal cell carcinoma is a malignant skin tumor with high incidence in our country, especially in rural areas, on sun-exposed skin (particularly on the face) in elderly patients. We present three cases of basal cell carcinoma with good results with cryotherapy. This report aims to outline and to prove that in some difficult situations, a simple, inexpensive, easy-to-perform procedure with no contraindications and with minimal side effects (erythema, mild pain) can be applied and resolve such cases. PMID:23569366

  19. Basal cell carcinomas in elderly patients treated by cryotherapy

    PubMed Central

    Chiriac, Anca; Mihaila, Doina; Foia, Liliana; Solovan, Caius

    2013-01-01

    Basal cell carcinoma is a malignant skin tumor with high incidence in our country, especially in rural areas, on sun-exposed skin (particularly on the face) in elderly patients. We present three cases of basal cell carcinoma with good results with cryotherapy. This report aims to outline and to prove that in some difficult situations, a simple, inexpensive, easy-to-perform procedure with no contraindications and with minimal side effects (erythema, mild pain) can be applied and resolve such cases. PMID:23569366

  20. Genome Damage in Oropharyngeal Cancer Patients Treated by Radiotherapy

    PubMed Central

    Gamulin, Marija; Kopjar, Nevenka; Grgić, Mislav; Ramić, Snježana; Bišof, Vesna; Garaj-Vrhovac, Vera

    2008-01-01

    Aim To estimate genome damage in oropharyngeal cancer patients before, during, and after radiotherapy and to measure the persistence of caused genome damage relevant in the evaluation of secondary cancer risk. Methods DNA damage was evaluated in peripheral blood lymphocytes of 10 oropharyngeal cancer patients using alkaline comet assay, analysis of structural chromosome aberrations, and micronucleus assay. Blood samples were taken 2 hours before irradiation on day 1 of the first radiotherapy cycle, 2 hours after the application of the first dose, in the middle of the radiotherapy cycle, within 2 hours after the last received radiotherapy dose, and after 6 and 12 months after radiotherapy. Results In most participants, the highest level of primary DNA damage was recorded in blood samples collected after the administration of first radiation dose (mean tail length 25.04 ± 6.23 μm). Most patients also had increased frequency of comets with long tail-nucleus (LTN comets) after the administration of the first radiation dose (mean, 10.50 ± 7.71 per 100 comets), which remained increased in the middle of radiotherapy (mean, 18.30 ± 27.62 per 100 comets). Later on, the levels of primary DNA damage as recorded by the comet assay, slightly diminished. The frequency of structural chromosome aberrations in lymphocytes gradually increased during the radiation cycle (26.50 ± 27.72 per 100 metaphases at the end of the therapy), as well as the frequency of micronuclei (mean total number of micronuclei 167.20 ± 35.69; per 1000 binuclear cells). Conclusion Oropharyngeal cancer patients had relatively high levels of primary DNA damage in their peripheral blood lymphocytes even before therapy. The frequency of complex structural chromosome aberrations and the frequency of micronuclei increased with the progression of the radiation cycle and the doses delivered. As the frequency of chromosomal aberrations a year after radiotherapy mostly did not return to pre

  1. Chronic thromboembolic pulmonary hypertension: treat the patient not the haemodynamics.

    PubMed

    Dunne, Ben; van den Broek, Annika; Williams, Vaughan; Smith, Gregory; Revesz, Tamas; Edwards, Mark; Gabbay, Eli

    2012-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disabling condition that is being increasingly recognised. It is unique as a cause of pulmonary hypertension in that it is surgically curable. We wish to highlight the importance of recognition and early referral of any patient who may have CTEPH even in the absence of resting pulmonary hypertension as excellent results can be achieved by restoring pulmonary vascular anatomy, reducing exercise-induced pulmonary hypertension, and reducing dead-space ventilation. We present a case that illustrates these points and discuss our experience as a referral centre for CTEPH. PMID:23133777

  2. Chronic Thromboembolic Pulmonary Hypertension: Treat the Patient Not the Haemodynamics

    PubMed Central

    Dunne, Ben; van den Broek, Annika; Williams, Vaughan; Smith, Gregory; Revesz, Tamas; Edwards, Mark; Gabbay, Eli

    2012-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a disabling condition that is being increasingly recognised. It is unique as a cause of pulmonary hypertension in that it is surgically curable. We wish to highlight the importance of recognition and early referral of any patient who may have CTEPH even in the absence of resting pulmonary hypertension as excellent results can be achieved by restoring pulmonary vascular anatomy, reducing exercise-induced pulmonary hypertension, and reducing dead-space ventilation. We present a case that illustrates these points and discuss our experience as a referral centre for CTEPH. PMID:23133777

  3. Autocapture enhancements: unipolar and bipolar lead compatibility and bipolar pacing capability on bipolar leads.

    PubMed

    Binner, Ludwig; Messenger, John; Sperzel, Johannes; Bondke, Hansjürgen; Vandekerckhove, Yves; Poore, John; Scheiner, Jöerg; Berkhof, Marc; Park, Euljoon; Holmström, Nils; Bornzin, Gene A

    2003-01-01

    Beat-by-beat Autocapture maximizes device longevity by minimizing stimulus amplitude while assuring patient safety. Currently, Autocapture permits use of only bipolar leads. The authors have devised a detection method that operates with unipolar and bipolar leads and covers all pacing and sensing combinations (but bipolar pace and sense simultaneously). This new detection method for unipolar sensing uses the integral of the negative portion of the unipolar evoked response as a robust capture detection feature. When using bipolar leads, the method provides the flexibility of bipolar or unipolar pacing. In this study, unipolar ventricular intracardiac electrograms (EGMs) were recorded in 71 patients, 73.7 +/- 9.9 years of age; 9 with high polarization, 62 with low polarization. High polarization had polished platinum or activated carbon electrodes. Low polarization had TiN, platinized platinum, or IrOx electrodes. The intracardiac EGMs were recorded 544 +/- 796 days after implant. The pacemakers performed an automatic capture threshold test while the intracardiac EGM signals were recorded in a programmer. These digitized signals were saved for off-line analysis. The unipolar evoked response was calculated at up to six (depending on capture threshold) pacing voltages and the polarization integral at 4.5 V and at loss of capture. An automatic calibration algorithm determined if the signal-to-noise ratio was adequate for Autocapture operation. Autocapture was possible with 60 of 62 of the low polarizations, and with 6 of 9 of the high polarizations. The average values form the data collected were: average unipolar evoked response--4.1 +/- 2.1 mV, average peak negative voltage--10.0 +/- 3.7 mV, average polarization 0.3 +/- 0.34 mV, and average signal-to-noise ratio (unipolar evoked response/ polarization) 38 +/- 71. In all cases the algorithm correctly determined the appropriateness of using Autocapture with the electrodes tested and the unipolar evoked response

  4. State-dependent increase in the levels of neurotrophin-3 and neurotrophin-4/5 in patients with bipolar disorder: A meta-analysis.

    PubMed

    Tseng, Ping-Tao; Chen, Yen-Wen; Tu, Kun-Yu; Wang, Hung-Yu; Chung, Weilun; Wu, Ching-Kuan; Hsu, Shih-Pin; Kuo, Hung-Chang; Lin, Pao-Yen

    2016-08-01

    Bipolar disorder (BD) is one of the most serious psychiatric disorders in the world, but its pathophysiology is still unclear. Regulation of neurotrophic factors have been thought to play a role in this process. There have been inconsistent findings regarding the differences in blood neurotrophin-3 (NT-3) and neurotrophin-4/5 (NT-4/5) between patients with BD and healthy controls (HCs). The aim of the current meta-analysis is to examine the changes in the levels of NT-3 and NT-4/5 in BD patients at different affective states. Eight articles (including 465 BD patients and 353 HCs) were included in the analysis, and their results were pooled by using a random effects model. We found the levels of both NT-3 (p = 0.0046) and NT-4/5 (p = 0.0003) were significantly increased in BD patients, compared to HCs. Through subgroup analysis, this increase persisted only in patients in depressed state (p = 0.0038 for NT-3 and p = 0.0001 for NT-4/5), but not in manic or euthymic state. In addition, we found the differences in NT-3 and NT-4/5 were significantly associated with the duration of illness, but not by the mean age or female proportion. Our results suggest a state-dependent increase in NT-3 and NT-4/5 levels in patients with BD. Further studies are needed to examine dynamic changes of these neurotrophins in BD patients along the disease course. PMID:27214525

  5. XK469R in Treating Patients With Refractory Hematologic Cancer

    ClinicalTrials.gov

    2013-02-07

    Adult Acute Basophilic Leukemia; Adult Acute Eosinophilic Leukemia; Adult Acute Megakaryoblastic Leukemia (M7); Adult Acute Minimally Differentiated Myeloid Leukemia (M0); Adult Acute Monoblastic Leukemia (M5a); Adult Acute Monocytic Leukemia (M5b); Adult Acute Myeloblastic Leukemia With Maturation (M2); Adult Acute Myeloblastic Leukemia Without Maturation (M1); Adult Acute Myeloid Leukemia With 11q23 (MLL) Abnormalities; Adult Acute Myeloid Leukemia With Inv(16)(p13;q22); Adult Acute Myeloid Leukemia With t(16;16)(p13;q22); Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); Adult Acute Myelomonocytic Leukemia (M4); Adult Erythroleukemia (M6a); Adult Pure Erythroid Leukemia (M6b); Blastic Phase Chronic Myelogenous Leukemia; Chronic Myelomonocytic Leukemia; de Novo Myelodysplastic Syndromes; Previously Treated Myelodysplastic Syndromes; Recurrent Adult Acute Lymphoblastic Leukemia; Recurrent Adult Acute Myeloid Leukemia; Refractory Anemia With Excess Blasts; Refractory Anemia With Excess Blasts in Transformation; Refractory Chronic Lymphocytic Leukemia; Relapsing Chronic Myelogenous Leukemia; Secondary Myelodysplastic Syndromes; Stage III Chronic Lymphocytic Leukemia; Stage IV Chronic Lymphocytic Leukemia; Untreated Adult Acute Myeloid Leukemia

  6. Peripheral Endocannabinoid System Activity in Patients Treated With Sibutramine

    PubMed Central

    Engeli, Stefan; Heusser, Karsten; Janke, Jürgen; Gorzelniak, Kerstin; Bátkai, Sándor; Pacher, Pál; Harvey-White, Judith; Luft, Friedrich C.; Jordan, Jens

    2008-01-01

    Objective The endocannabinoid system (ECS) promotes weight gain and obesity-associated metabolic changes. Weight loss interventions may influence obesity-associated risk indirectly through modulation of the peripheral ECS. We investigated the effect of acute and chronic treatment with sibutramine on components of the peripheral ECS. Methods and Procedures Twenty obese otherwise healthy patients received randomized, double-blind, crossover treatment with placebo and 15 mg/day sibutramine for 5 days each, followed by 12 weeks open-label sibutramine treatment. We determined circulating anandamide and 2-arachidonoylglycerol and expression levels of endocannabinoid genes in subcutaneous abdominal adipose tissue biopsies. Results Body weight was stable during the acute treatment period and decreased by 6.0 ± 0.8 kg in those patients completing 3 months of sibutramine treatment (P < 0.05). Circulating endocannabinoids and the expression of ECS genes did not change with acute or chronic sibutramine treatment. Discussion The ECS is activated in obesity. We did not find any influence of 5% body weight loss induced by sibutramine on circulating levels of endocannabinoids and adipose-tissue expression of endocannabinoid genes in obese subjects. These data confirm our previous findings on dietary weight loss and suggest that the dysregulation of the ECS may be a cause rather than a consequence of obesity. PMID:18356837

  7. Self-esteem in patients treated for anorexia nervosa.

    PubMed

    Karpowicz, Ewa; Skärsäter, Ingela; Nevonen, Lauri

    2009-10-01

    Anorexia nervosa (AN) mainly affects girls or women between 13 and 45 years of age. According to previous studies, one of the reasons for the desire to be thin is low self-esteem. The purpose of the study was to examine the self-esteem of 38 female patients with AN between 16 and 25 years of age, before and after 3 months of treatment at a specialist ward for eating disorders in Göteborg, Sweden. A quantitative pre- and post-assessment based on two self-rating questionnaires, the Rosenberg Self-Esteem Scale (RSE-S) and three subscales (weight phobia, body dissatisfaction, and ineffectiveness) of Eating Disorder Inventory-2 (EDI-2), together with body mass index (BMI), were used in the study, which was conducted between June 2005 and March 2008. The results reveal that self-esteem, BMI, weight phobia, and body dissatisfaction improved significantly between pre- and post-treatment. The RSE-S and EDI-2 ineffectiveness correlate highly with one another, which lends support to convergent validity, and the internal consistency was high for both the RSE-S and EDI-2 ineffectiveness. The results indicate that the treatment was effective, as both patients' self-esteem and BMI increased after completed treatment, which was the primary goal of the treatment at this ward. Future studies should focus on follow up and the way self-esteem manifests itself at different points in time within an individual. PMID:19740141

  8. Validation of the Chinese version of the "Mood Disorder Questionnaire" for screening bipolar disorder among patients with a current depressive episode

    PubMed Central

    2012-01-01

    Background The Mood Disorder Questionnaire (MDQ) is a well-recognized screening tool for bipolar disorder, but its Chinese version needs further validation. This study aims to measure the accuracy of the Chinese version of the MDQ as a screening instrument for bipolar disorder (BPD) in a group of patients with a current major depressive episode. Methods 142 consecutive patients with an initial DSM-IV-TR diagnosis of a major depressive episode were screened for BPD using the Chinese translation of the MDQ and followed up for one year. The final diagnosis, determined by a special committee consisting of three trained senior psychiatrists, was used as a 'gold standard' and ROC was plotted to evaluate the performance of the MDQ. The optimal cut-off was chosen by maximizing the Younden's index. Results Of the 142 patients, 122 (85.9%) finished the one year follow-up. On the basis of a semi-structured clinical interview 48.4% (59/122) received a diagnosis of unipolar depression (UPD), 36.9% (45/122) BPDII and 14.8% (18/122) BPDI. At the end of the one year follow-up,9 moved from UPD to BPD, 2 from BPDII to UPD, 1 from BPDII to BPDI, the overall rate of initial misdiagnosis was 16.4%. MDQ showed a good accuracy for BPD: the optimal cut-off was 4, with a sensitivity of 0.72 and a specificity of 0.73. When BPDII and BPDI were calculated independently, the optimal cut-off for BPDII was 4, with a sensitivity of 0.70 and a specificity of 0.73; while the optimal cut-off for BPDI was 5, with a sensitivity of 0.67 and a specificity of 0.86. Conclusions Our results show that the Chinese version of MDQ is a valid tool for screening BPD in a group of patients with current depressive episode on the Chinese mainland. PMID:22293033

  9. Doppler flow evaluation of pathologic endometrial conditions in postmenopausal breast cancer patients treated with tamoxifen.

    PubMed

    Tepper, R; Cohen, I; Altaras, M; Shapira, J; Cordoba, M; Dror, Y; Beyth, Y

    1994-08-01

    A prospective pilot study was conducted to evaluate the usefulness of uterine artery blood flow in the detection of various pathologic endometrial conditions in 39 asymptomatic postmenopausal breast cancer patients who were treated with tamoxifen. No specific pattern was seen for the uterine artery pulsatility index values in the tamoxifen-treated patients that could be related to any specific endometrial lesions, nor were any specific changes observed in the pulsatility index value with increasing severity of the pathologic endometrial conditions. Similarly, no correlation was found between ultrasonographically measured endometrial widths and uterine artery pulsatility index values. Thus, although pulsed Doppler flow ultrasonography has been shown previously to be effective in the detection of uterine cancer in non-tamoxifen-treated post-menopausal patients, it probably does not contribute to the assessment of endometrial lesions in post-menopausal breast cancer patients treated with tamoxifen. PMID:7933033

  10. Physical Therapy to Treat Torn Meniscus Comparable to Surgery for Many Patients

    MedlinePlus

    ... 2013 August 2013 (historical) Physical Therapy to Treat Torn Meniscus Comparable to Surgery for Many Patients Many ... arthroscopic partial meniscectomy that involves surgically removing the torn part of the meniscus and stabilizing it, or ...

  11. [The efficacy of treating patients with allergic diseases at a health resort with a gastroenterologic profile].

    PubMed

    Avdeeva, E V; Pavlushchenko, E V; Vaganova, V S; Paniushkina, O N

    1998-01-01

    45 allergic patients were treated in gastrointestinal sanatorium. Balneological and speleo modalities were employed. The clinical symptoms and humoral immunity indicated high efficacy of such treatment. The complex is recommended for introduction in gastrointestinal sanatoria. PMID:9987974

  12. The International Society for Bipolar Disorders (ISBD) Task Force Report on Antidepressant Use in Bipolar Disorders

    PubMed Central

    Pacchiarotti, Isabella; Bond, David J.; Baldessarini, Ross J.; Nolen, Willem A.; Grunze, Heinz; Licht, Rasmus W.; Post, Robert M.; Berk, Michael; Goodwin, Guy M.; Sachs, Gary S.; Tondo, Leonardo; Findling, Robert L.; Youngstrom, Eric A.; Tohen, Mauricio; Undurraga, Juan; González-Pinto, Ana; Goldberg, Joseph F.; Yildiz, Ayşegül; Altshuler, Lori L.; Calabrese, Joseph R.; Mitchell, Philip B.; Thase, Michael E.; Koukopoulos, Athanasios; Colom, Francesc; Frye, Mark A.; Malhi, Gin S.; Fountoulakis, Konstantinos N.; Vázquez, Gustavo; Perlis, Roy H.; Ketter, Terence A.; Cassidy, Frederick; Akiskal, Hagop; Azorin, Jean-Michel; Valentí, Marc; Mazzei, Diego Hidalgo; Lafer, Beny; Kato, Tadafumi; Mazzarini, Lorenzo; Martínez-Aran, Anabel; Parker, Gordon; Souery, Daniel; Özerdem, Ayşegül; McElroy, Susan L.; Girardi, Paolo; Bauer, Michael; Yatham, Lakshmi N.; Zarate, Carlos A.; Nierenberg, Andrew A.; Birmaher, Boris; Kanba, Shigenobu; El-Mallakh, Rif S.; Serretti, Alessandro; Rihmer, Zoltan; Young, Allan H.; Kotzalidis, Georgios D.; MacQueen, Glenda M.; Bowden, Charles L.; Ghaemi, S. Nassir; Lopez-Jaramillo, Carlos; Rybakowski, Janusz; Ha, Kyooseob; Perugi, Giulio; Kasper, Siegfried; Amsterdam, Jay D.; Hirschfeld, Robert M.; Kapczinski, Flávio; Vieta, Eduard

    2014-01-01

    Objective The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders. Method An expert task force iteratively developed consensus through serial consensus-based revisions using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new or reworded items and items that needed to be rerated. This process resulted in the final ISBD Task Force clinical recommendations on antidepressant use in bipolar disorder. Results There is striking incongruity between the wide use of and the weak evidence base for the efficacy and safety of antidepressant drugs in bipolar disorder. Few well-designed, long-term trials of prophylactic benefits have been conducted, and there is insufficient evidence for treatment benefits with antidepressants combined with mood stabilizers. A major concern is the risk for mood switch to hypomania, mania, and mixed states. Integrating the evidence and the experience of the task force members, a consensus was reached on 12 statements on the use of antidepressants in bipolar disorder. Conclusions Because of limited data, the task force could not make broad statements endorsing antidepressant use but acknowledged that individual bipolar patients may benefit from antidepressants. Regarding safety, serotonin reuptake inhibitors and bupropion may have lower rates of manic switch than tricyclic and tetracyclic antidepressants and norepinephrine-serotonin reuptake inhibitors. The frequency and severity of antidepressant-associated mood elevations appear to be greater in bipolar I than bipolar II disorder. Hence, in bipolar I patients antidepressants should be prescribed only as an adjunct to mood-stabilizing medications

  13. Reduced Acute Bowel Toxicity in Patients Treated With Intensity-Modulated Radiotherapy for Rectal Cancer

    SciTech Connect

    Samuelian, Jason M.; Callister, Matthew D.; Ashman, Jonathan B.; Young-Fadok, Tonia M.; Borad, Mitesh J.; Gunderson, Leonard L.

    2012-04-01

    Purpose: We have previously shown that intensity-modulated radiotherapy (IMRT) can reduce dose to small bowel, bladder, and bone marrow compared with three-field conventional radiotherapy (CRT) technique in the treatment of rectal cancer. The purpose of this study was to review our experience using IMRT to treat rectal cancer and report patient clinical outcomes. Methods and Materials: A retrospective review was conducted of patients with rectal cancer who were treated at Mayo Clinic Arizona with pelvic radiotherapy (RT). Data regarding patient and tumor characteristics, treatment, acute toxicity according to the Common Terminology Criteria for Adverse Events v 3.0, tumor response, and perioperative morbidity were collected. Results: From 2004 to August 2009, 92 consecutive patients were treated. Sixty-one (66%) patients were treated with CRT, and 31 (34%) patients were treated with IMRT. All but 2 patients received concurrent chemotherapy. There was no significant difference in median dose (50.4 Gy, CRT; 50 Gy, IMRT), preoperative vs. postoperative treatment, type of concurrent chemotherapy, or history of previous pelvic RT between the CRT and IMRT patient groups. Patients who received IMRT had significantly less gastrointestinal (GI) toxicity. Sixty-two percent of patients undergoing CRT experienced {>=}Grade 2 acute GI side effects, compared with 32% among IMRT patients (p = 0.006). The reduction in overall GI toxicity was attributable to fewer symptoms from the lower GI tract. Among CRT patients, {>=}Grade 2 diarrhea and enteritis was experienced among 48% and 30% of patients, respectively, compared with 23% (p = 0.02) and 10% (p = 0.015) among IMRT patients. There was no significant difference in hematologic or genitourinary acute toxicity between groups. In addition, pathologic complete response rates and postoperative morbidity between treatment groups did not differ significantly. Conclusions: In the management of rectal cancer, IMRT is associated with a

  14. The developmental stages of Bipolar Disorder: a case report.

    PubMed

    Chaudhry, Fatima Imam; Verdolini, Norma; Agius, Mark

    2015-09-01

    Bipolar disorder is a developing disorder; its early stages are sometimes misdiagnosed as anxiety or depressive disorders. At the same time, these disorders are often in comorbidity with bipolar disorder. This complex symptomatology can lead to misinterpretation and underdiagnosis of bipolar disorders, mainly at the earliest stages. Consequently, one of the most important challenges for clinicians is to recognize the non specific early symptoms with the aid of clinical information, for example a family history of bipolar disorder. Furthermore, it is well-known that comorbid anxiety disorders can lead to a worse prognosis in bipolar patients but it is not exactly clear to what extent. A deeper understanding of the relationship between these comorbidities and their stage of development will hopefully lead to better care of patients with bipolar disorder from a younger age. PMID:26417761

  15. Recognising Bipolar Disorders in Primary Care.

    PubMed

    Dietch, Daniel

    2015-09-01

    Bipolar disorder, previously called 'Manic-depression', is a complex group of conditions characterised by recurrent changes in mood and energy. Crucially, the intensity and duration of these changes go beyond normal fluctuations and personality traits. Bipolar Disorder is a mental health disorder, but physical health manifestations (Smith 2013, Westman 2013, Fagiolini 2008, Young 2013) and complications are just as important. GPs have a key role in the recognition and management, in conjunction with secondary care colleagues. Diagnosis is often difficult and may take several years (Smith 2011, Angst 2005, Manning 2010), because patients usually seek help for anxiety, depression or fatigue, not hypomania/mania, which they may not recognise. Individuals with a first episode of mania are more likely to present directly to secondary care, sometimes via a third party alerting the emergency services. There is also debate around the classification, diagnosis and treatment of individuals with brief and milder mood changes ('bipolar spectrum disorder') (Faravelli 2009, Spence 2011). In the UK, the recent NICE Guidelines (2014) 1 only included Bipolar I and Bipolar II for these reasons. A particular challenge for GPs is that whilst most people who have Bipolar Disorder (and especially Bipolar II) are depressed, most people with depression within a Primary Care setting do not have Bipolar Disorder. Thus, a brief pragmatic screen is recommended in Primary care: ask about a family history of Bipolar Disorder and screen for a history of mania/hypomania in individuals with anxiety, depression or irritability, especially if there are recurrent episodes, suicidal thoughts or a previous suicide attempt. For suspected cases, formal diagnosis should not be made within Primary Care but individuals should be referred for Psychiatric assessment, ideally to a Mood Disorders specialist. PMID:26417759

  16. A clinical contrast: physical therapists with low back pain treating patients with low back pain.

    PubMed

    Louw, Adriaan; Puentedura, Emilio J; Zimney, Kory

    2015-01-01

    Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery. PMID:26451623

  17. The risk of varicella zoster virus infection in multiple sclerosis patients treated with fingolimod.

    PubMed

    Tanaka, Masami

    2016-04-28

    Fingolimod, a sphingosine-1-phosphate receptor modulator, inhibits the egress of CCR7-positive lymphocytes, including encephalitogenic lymphocytes, from lymph nodes and may sometimes cause lymphopenia. A recent study reported that varicella zoster virus reactivation occurred in the saliva of 20% of multiple sclerosis (MS) patients treated with fingolimod. I compared the risk of developing herpes zoster between 32 MS patients treated with fingolimod (FTY-MS) and 45 patients, including those with neuromyelitis optica spectrum disorder, horizontal hemianopsia without anti-aquaporin-4 antibodies, and myelitis with anti-myelin oligodendrocyte glycoprotein antibodies, treated with tacrolimus (TCR-NMO). The risk of developing herpes zoster in FTY-MS (40/1,000 patient-years) was significantly higher than that in TCR-NMO (6/1,000 patient-years) (P < 0.0001, odds ratio: 6.90). The incidence of herpes zoster of patients with rheumatoid arthritis treated with Tofacitinib in Asian countries has been shown to be higher than those of patients in the United States or European countries. It may be better to pay more attention to develop herpes zoster in Japanese MS patients treated with fingolimod. PMID:27010095

  18. New Approaches to Treating Cardiac Cachexia in the Older Patient.

    PubMed

    Azhar, Gohar; Wei, Jeanne Y

    2013-12-01

    Congestive heart failure (CHF) is a leading cause of morbidity and mortality in the elderly, accounting for more hospitalizations than any other condition. Advanced stages of congestive heart failure can be associated with serious complications such as cardiac cachexia (defined here as unintentional weight loss of more than 6% in 6 months). Cardiac cachexia and the associated progressive weight loss are sometimes overlooked by older patients, their families and care providers. A delay in the diagnosis can result in further loss of vital organ tissue, progressive weakness, fall-related injuries and even long-term care institutionalization and/or death. During the past several years, researchers have begun to broaden their understanding of this common, morbid and often fatal condition, and these findings will help to characterize the features that assist in its diagnosis, minimize its exacerbation, delay the progressive decline, and educate clinicians about the potential management options. PMID:24489977

  19. Dawn of a new era: the completely interventionally treated patient.

    PubMed

    Kypta, Alexander; Blessberger, Hermann; Lichtenauer, Michael; Steinwender, Clemens

    2016-01-01

    A frail 75-year-old woman with permanent atrial fibrillation and angina pectoris was admitted to our department for further evaluation. Echocardiography revealed concurrent severe aortic valve stenosis. Furthermore, significant coronary artery stenoses were identified on the coronary angiogram. We chose the following treatment strategy: first, two drug eluting stents were implanted successfully in the left anterior descending and circumflex artery, respectively. Second, a 23 mm Core Valve bioprosthesis (Medtronic Inc, Minneapolis, Minnesota, USA) was implanted without complications within the same session. Two weeks after hospital discharge, the patient showed up at our outpatient department, with a symptomatic complete atrioventricular-block with an escape rhythm of 35 bpm. Thus, finally, a leadless pacemaker Micra (Medtronic Inc) was implanted via a transvenous transfemoral access without any complications. PMID:26994050

  20. [Driving fitness/driving capacity of patients treated with methadone].

    PubMed

    Hauri-Bionda, R; Bär, W; Friedrich-Koch, A

    1998-10-10

    To answer the question whether or not therapeutic methadone doses significantly reduce traffic-related performance of drivers on medically supervised methadone programmes, 34 methadone substitution patients, all of them volunteers, were subjected to a test series: the focus of the study was a psychophysical test battery consisting of 10 individual performance tests to assess essential functions with regard to driving ability, such as concentration, attention, reaction capability, memory, perception and sensorimotor coordination. In evaluating the results of the psychophysical tests, multiple drug use and subjective methadone influence at the time of the examination were taken into consideration but current methadone blood level was neglected. The results were compared to those of a control group. The methadone group (n = 34) consisted of 25 men and 9 women aged between 18 and 38. At the time of the study, the majority of the test persons (29) were on low dosage methadone maintenance (up to 60 mg/day). In the urine samples of approximately 2/3 of the test persons, evidence was found for multiple drug use together with other psychotropic substances, the most frequent (14) being cannabis metabolites. Referring to their driving practices, a mere 4 out of 29 drivers had not committed any driving offences. A comparison of the psychophysical performance of the whole methadone group (n = 34) with a control group demonstrated that the methadone substitution patients achieved rather lower results in almost all variables. These performance deficits were particularly conspicuous in sustained attention, sensorimotor coordination and reaction capability. 12 "methadone only" participants, i.e. methadone probands without any additional consumption of psychotropic substances showed-partly considerably-better performance than the methadone group as a whole and also achieved normal results in relation to the test norm. Nevertheless, once again, results tended to be of lower level in

  1. Understanding and Managing Erectile Dysfunction in Patients Treated for Cancer.

    PubMed

    Annam, Kiran; Voznesensky, Maria; Kreder, Karl J

    2016-04-01

    Cancer can cause sexual adverse effects by direct and indirect pathways. It can involve sexual organs, indirectly affect body image, or cause fatigue or depression with subsequent effects on libido. Erectile dysfunction (ED), the inability to obtain or maintain an erection firm enough for sexual intercourse, can also result from adverse effects of cancer treatment, such as fatigue, pain, or anxiety about therapy. In addition, depressed feelings about having cancer can affect sexuality, causing a range of signs and symptoms that can lead to ED. Chemotherapy, hormone therapy, surgery, and radiation can all cause sexual adverse effects. Additional factors that play a role include patient age and degree of ED before starting cancer treatment. In this article, we discuss how chemotherapy, hormone therapy, surgery, and radiation affect erectile function as well as possible treatment options for ED. PMID:27072383

  2. Syncope in a patient being treated for hepatic and intestinal amoebiasis

    PubMed Central

    Yelve, Kavita; Phatak, Sanat; Patil, Meenakshi Amit; Pazare, Amar R

    2012-01-01

    A 63-year-old man presented to our hospital with amoebic liver abscess and was treated successfully for the same. During the course of his treatment, he developed syncopal attacks and was found to have Torsades de Pointes on electrocardiogram. The patient was treated with intravenous magnesium and direct current cardioversion. Hypokalaemia, chloroquine and sepsis were suspected to have precipitated the arrhythmia. The patient remained arrhythmia-free following the correction of these factors. PMID:23203174

  3. Quality of Life in Methadone Maintenance Treated Patients in Iran

    PubMed Central

    Aghayan, Shahrokh; Amiri, Mohammad; Chaman, Reza; Khosravi, Ahmad

    2015-01-01

    Background: Measurement of life quality as an index of health status has a widespread application in health care domain. Objectives: The current study aimed to determine the quality of life of referents to addiction cessation centers of Iran. Patients and Methods: In this cross-sectional study, 988 addicts who had referred to addiction cessation centers in Shahroud were studied through SF-36 questionnaire. The data were analyzed using linear regression in structural equation modeling and STATA 12 statistical software. Results: The mean ± SD age of the participants was 41.2 ± 11.8 years. Most of the referents used smoking followed by eating method of opium abuse. The mean ± SD score of life quality was 67.8 ± 17.2, the mean ± SD score of life quality in physical health dimension was 76.9 ± 26.7, and the mean ± SD score in mental health dimension was 64.5 ± 18.4. Univariate analysis showed a significant relationship between life quality and gender, place of residence, education, occupation, marital status, and income (P ≤ 0.05). However, in multivariate analysis a significant relationship was observed only between gender, socioeconomic status, and quality of life score. Conclusions: Although most studies have reported low and weak quality of life in addicts, the findings of this study shows that the life quality score of addicts is rather good. It seems that the maintenance treatment that addicts receive in addiction cessation centers has been effective in improving the quality of life of the patients. Hence, expanding methadone treatment centers can play a leading role in the improvement of life quality in addicts. PMID:26870708

  4. Do high functioning autistic individuals treated in a residential setting differ in divided attention abilities from those treated in an out-patient setting?

    PubMed

    Bogte, Hans; Flamma, Bert; van der Meere, Jaap

    2002-01-01

    The goal of this current study was to test divided attention abilities of a group adults with autism and normal intellectual functioning, treated in a residential setting versus those treated in an out-patient setting. Both groups were compared with a control group using the Sternberg (1969) reaction time paradigm. It appeared that the in-patient group suffered from a divided attention deficit compared to a norm group. The patients treated in an out-patient setting scored in between the norm group and the in-patient group. Findings are discussed with respect to the relevance for the day to day clinical practice. PMID:12585817

  5. Antipsychotic drugs attenuate aberrant DNA methylation of DTNBP1 (dysbindin) promoter in saliva and post-mortem brain of patients with schizophrenia and Psychotic bipolar disorder.

    PubMed

    Abdolmaleky, Hamid M; Pajouhanfar, Sara; Faghankhani, Masoomeh; Joghataei, Mohammad Taghi; Mostafavi, Ashraf; Thiagalingam, Sam

    2015-12-01

    Due to the lack of genetic association between individual genes and schizophrenia (SCZ) pathogenesis, the current consensus is to consider both genetic and epigenetic alterations. Here, we report the examination of DNA methylation status of DTNBP1 promoter region, one of the most credible candidate genes affected in SCZ, assayed in saliva and post-mortem brain samples. The Illumina DNA methylation profiling and bisulfite sequencing of representative samples were used to identify methylation status of the DTNBP1 promoter region. Quantitative methylation specific PCR (qMSP) was employed to assess methylation of DTNBP1 promoter CpGs flanking a SP1 binding site in the saliva of SCZ patients, their first-degree relatives and control subjects (30, 15, and 30/group, respectively) as well as in post-mortem brains of patients with SCZ and bipolar disorder (BD) versus controls (35/group). qRT-PCR was used to assess DTNBP1 expression. We found DNA hypermethylation of DTNBP1 promoter in the saliva of SCZ patients (∼12.5%, P = 0.036), particularly in drug-naïve patients (∼20%, P = 0.011), and a trend toward hypermethylation in their first-degree relatives (P = 0.085) versus controls. Analysis of post-mortem brain samples revealed an inverse correlation between DTNBP1 methylation and expression, and normalization of this epigenetic change by classic antipsychotic drugs. Additionally, BD patients with psychotic depression exhibited higher degree of methylation versus other BD patients (∼80%, P = 0.025). DTNBP1 promoter DNA methylation may become a key element in a panel of biomarkers for diagnosis, prevention, or therapy in SCZ and at risk individuals pending confirmatory studies with larger sample sizes to attain a higher degree of significance. PMID:26285059

  6. Classification of schizophrenia and bipolar patients using static and dynamic resting-state fMRI brain connectivity.

    PubMed

    Rashid, Barnaly; Arbabshirani, Mohammad R; Damaraju, Eswar; Cetin, Mustafa S; Miller, Robyn; Pearlson, Godfrey D; Calhoun, Vince D

    2016-07-01

    Recently, functional network connectivity (FNC, defined as the temporal correlation among spatially distant brain networks) has been used to examine the functional organization of brain networks in various psychiatric illnesses. Dynamic FNC is a recent extension of the conventional FNC analysis that takes into account FNC changes over short periods of time. While such dynamic FNC measures may be more informative about various aspects of connectivity, there has been no detailed head-to-head comparison of the ability of static and dynamic FNC to perform classification in complex mental illnesses. This paper proposes a framework for automatic classification of schizophrenia, bipolar and healthy subjects based on their static and dynamic FNC features. Also, we compare cross-validated classification performance between static and dynamic FNC. Results show that the dynamic FNC significantly outperforms the static FNC in terms of predictive accuracy, indicating that features from dynamic FNC have distinct advantages over static FNC for classification purposes. Moreover, combining static and dynamic FNC features does not significantly improve the classification performance over the dynamic FNC features alone, suggesting that static FNC does not add any significant information when combined with dynamic FNC for classification purposes. A three-way classification methodology based on static and dynamic FNC features discriminates individual subjects into appropriate diagnostic groups with high accuracy. Our proposed classification framework is potentially applicable to additional mental disorders. PMID:27118088

  7. Outcome in patients with idiopathic retroperitoneal fibrosis treated with corticosteroid or tamoxifen monotherapy

    PubMed Central

    van der Bilt, Floor E.; Hendriksz, Tadek R.; van der Meijden, Wilbert A.G.; Brilman, Lisette G.; van Bommel, Eric F.H.

    2016-01-01

    Background Although corticosteroids (CS) are used primarily in idiopathic retroperitoneal fibrosis (iRPF), tamoxifen (TMX) may be a suitable alternative. We compared outcome with CS or TMX monotherapy for first presentation in a large group of patients with iRPF disease. Methods Of all patients with iRPF disease who were seen at our tertiary care referral centre from February 1999 to December 2011, 118 patients were eligible for this retrospective study. Treatment success was defined as the composite of (i) amelioration of symptoms, (ii) computed tomography (CT)-documented mass regression and, if applicable, (iii) definitive removal of ureteral stent or nephrostomy tube. Recurrence was defined as recurrence of signs and symptoms and/or CT-documented mass increase after initial treatment success with primary treatment. Results Presenting signs and symptoms did not differ between patients treated with CS (n = 50) or TMX (n = 68). Time to amelioration of symptoms after treatment initiation was shorter in CS-treated patients [CS, 2.0 (0.8–3.8) weeks versus TMX, 4.0 (2.0–6.0) weeks; P < 0.01]. Short-term percentual decrease in acute-phase reactant levels (P < 0.001 for both erythrocyte sedimentation rate and C-reactive protein) and serum creatinine level (P < 0.01) following treatment initiation was greater in CS-treated patients compared with that in TMX-treated patients. Mass regression at first follow-up CT scan was observed more frequently in CS-treated patients (CS, 84.0% versus TMX, 68.3%; P = 0.05) with no difference in time interval from treatment initiation to first follow-up CT between groups [CS, 5 (2–7) months versus TMX, 4 (4–5) months; P = 0.34]. Definite treatment success was non-significantly higher in CS-treated patients (CS, 72.7% versus TMX, 58.3%; P = 0.15). In patients with initial treatment success with primary treatment, recurrence rate was lower in TMX-treated patients (CS, 62.5% versus TMX, 21.4%; P < 0.01). Conclusions CS are superior

  8. Pros and cons of approved therapies for bipolar depression and ongoing unmet needs.

    PubMed

    McElroy, Susan L

    2014-10-01

    Patients with bipolar disorder spend more time depressed than manic, but fewer clinical trials have been conducted investigating treatments for bipolar depression than for bipolar mania. Olanzapine-fluoxetine combination, quetiapine, and lurasidone are the only FDA-approved treatments for bipolar depression. Clinical trials of these drugs show similar efficacy but different side effect profiles. Clinicians, therefore, should consider possible adverse events and individual patient characteristics when selecting treatments. PMID:25373131

  9. The Comparison of Compression Hip Screw and Bipolar Hemiarthroplasty for the Treatment of AO Type A2 Intertrochanteric Fractures

    PubMed Central

    Kim, Yee-Suk; Hur, Jae-Seung; Hwang, Kyu-Tae; Choi, Il-Yong

    2014-01-01

    Purpose The purpose of this study was to compare the outcomes of osteosynthesis using compression hip screw fixation versus bipolar hemiarthroplasty in AO type A2 intertrochanteric fractures. Materials and Methods From March 2003 to December 2009, 89 patients were included in this study. They were treated using compression hip screws (43 cases) or bipolar hemiarthroplasty (46 cases). The mean age of patients was 77.7 years (65-94 years) and the mean follow-up period was 5.9 years (1-8.3 years). For comparison of the outcomes in the two groups, statistical analyses were performed with parameters including anesthesia time, operation time, amount of transfusion, hospital stay, general complications, clinical outcome, time of partial weight-bearing using a walker, and radiological failure rate. Results Differences in the amount of transfusion, general complications, and clinical outcome (Merle d'Aubigné and Postel score) were not statistically significant between the two groups. The bipolar hemiarthroplasty group showed better results than the compression hip screw group for anesthesia time and the time of partial weight-bearing using a walker. Radiological failures were observed in hips in one case (2.2%) of bipolar hemiarthroplasty, and in four cases (9.3%) of compression hip screw fixation. Conclusion Among elderly individuals with AO type A2 intertrochanteric fractures, patients treated with bipolar hemiarthroplasty were able to perform early ambulation. However, no significant difference in operation time, amount of postoperative transfusion, clinical results, hospital stay, and radiological failure rate was observed between the bipolar hemiarthroplasty and compression hip screw fixation groups.

  10. The development of lurasidone for bipolar depression.

    PubMed

    Loebel, Antony; Xu, Jane; Hsu, Jay; Cucchiaro, Josephine; Pikalov, Andrei

    2015-11-01

    Bipolar disorder is a chronic, recurrent illness that ranks among the top 10 causes of disability in the developed world. As the illness progresses, major depressive episodes increasingly predominate. However, few treatment options are available that have demonstrated efficacy in the treatment of bipolar depression, either as monotherapy or adjunctive therapy in combination with mood stabilizers. Lurasidone is an atypical antipsychotic drug that was initially developed for the treatment of schizophrenia. Since no previous atypical antipsychotic development program had proceeded directly from work on schizophrenia to bipolar depression, the decision to focus on this indication represented an innovation in central nervous system drug development and was designed to address a clinically significant unmet need. The current review summarizes key results of a clinical development program undertaken to characterize the efficacy and safety of lurasidone in patients diagnosed with bipolar depression. Lurasidone is currently the only treatment for bipolar depression approved in the United States as both a monotherapy and an adjunctive therapy with lithium or valproate. The approval of lurasidone expands available treatment options for patients with bipolar depression and provides a therapy with an overall favorable risk-benefit profile. PMID:26771990

  11. Adjunctive Minocycline in Clozapine Treated Schizophrenia Patients with Persistent Symptoms

    PubMed Central

    Kelly, Deanna L.; Sullivan, Kelli M.; McEvoy, Joseph P; McMahon, Robert P.; Wehring, Heidi J.; Liu, Fang; Warfel, Dale; Vyas, Gopal; Richardson, Charles M.; Fischer, Bernard A.; Keller, William R.; Mathew Koola, Maju; Feldman, Stephanie; Russ, Jessica C.; Keefe, Richard S.; Osing, Jennifer; Hubzin, Leeka; August, Sharon; Walker, Trina M.; Buchanan, Robert W.

    2015-01-01

    Objective Clozapine is the most effective antipsychotic for treatment refractory people with schizophrenia, yet many patients only partially respond. Accumulating preclinical and clinical data suggest benefits with minocycline. We tested adjunct minocycline to clozapine in a 10 week, double blind placebo-controlled trial. Primary outcomes tested were positive and cognitive symptoms, while avolition, anxiety/depression and negative symptoms were secondary outcomes. Methods Schizophrenia and schizoaffective participants (N=52) with persistent positive symptoms were randomized to receive adjunct minocycline (100 mg oral capsule twice daily) (N=29) or placebo (N=23). Results Brief Psychiatric Rating Scale (BPRS) psychosis factor (p=0.098, effect size ES=0.39) and BPRS total score (p=0.075, effect size 0.55) were not significant. A ≥30% change in total BPRS symptoms was observed in 7/28 (25%) among minocycline and 1/23 (4%) among placebo participants, respectively (p=0.044). Global cognitive function (MATRICS Consensus Cognitive Battery, MCCB) did not differ, although there was a significant variation in size of treatment effects among cognitive domains (p=0.03), with significant improvement in working memory favoring minocycline (p=0.023, ES 0.41). The SANS total score did not differ, but significant improvement in avolition with minocycline was noted (p=0.012, ES=0.34). Significant improvement in the BPRS anxiety/depression factor was observed with minocycline (p=0.028, ES=0.49). Minocycline was well tolerated with significantly fewer headaches and constipation compared to placebo. Conclusion Minocycline’s effect on the MCCB composite score and positive symptoms were not statistically significant. Significant improvements with minocycline were seen in working memory, avolition and anxiety/depressive symptoms in a chronic population with persistent symptoms. Larger studies are needed to validate these findings. PMID:26082974

  12. Regulators of mitochondrial complex I activity: A review of literature and evaluation in postmortem prefrontal cortex from patients with bipolar disorder.

    PubMed

    Duong, Angela; Che, Yi; Ceylan, Deniz; Pinguelo, Arsene; Andreazza, Ana C; Trevor Young, L; Berk, Michael

    2016-02-28

    Phenomenologically, bipolar disorder (BD) is characterized by biphasic increases and decreases in energy. As this is a state-related phenomenon, identifying regulators responsible for this phasic dysregulation has the potential to uncover key elements in the pathophysiology of BD. Given the evidence suggesting mitochondrial complex I dysfunction in BD, we aimed to identify the main regulators of complex I in BD by reviewing the literature and using the published microarray data to examine their gene expression profiles. We also validated protein expression levels of the main complex I regulators by immunohistochemistry. Upon reviewing the literature, we found PARK-7, STAT-3, SIRT-3 and IMP-2 play an important role in regulating complex I activity. Published microarray studies however revealed no significant direction of regulation of STAT-3, SIRT-3, and IMP-2, but a trend towards downregulation of PARK-7 was observed in BD. Immunocontent of DJ-1 (PARK-7-encoded protein) were not elevated in post mortem prefrontal cortex from patients with BD. We also found a trend towards upregulation of DJ-1 expression with age. Our results suggest that DJ-1 is not significantly altered in BD subjects, however further studies are needed to examine DJ-1 expression levels in a cohort of older patients with BD. PMID:26723136

  13. The microtubular cytoskeleton of olfactory neurons derived from patients with schizophrenia or with bipolar disorder: Implications for biomarker characterization, neuronal physiology and pharmacological screening.

    PubMed

    Benítez-King, G; Valdés-Tovar, M; Trueta, C; Galván-Arrieta, T; Argueta, J; Alarcón, S; Lora-Castellanos, A; Solís-Chagoyán, H

    2016-06-01

    Schizophrenia (SZ) and Bipolar Disorder (BD) are highly inheritable chronic mental disorders with a worldwide prevalence of around 1%. Despite that many efforts had been made to characterize biomarkers in order to allow for biological testing for their diagnoses, these disorders are currently detected and classified only by clinical appraisal based on the Diagnostic and Statistical Manual of Mental Disorders. Olfactory neuroepithelium-derived neuronal precursors have been recently proposed as a model for biomarker characterization. Because of their peripheral localization, they are amenable to collection and suitable for being cultured and propagated in vitro. Olfactory neuroepithelial cells can be obtained by a non-invasive brush-exfoliation technique from neuropsychiatric patients and healthy subjects. Neuronal precursors isolated from these samples undergo in vitro the cytoskeletal reorganization inherent to the neurodevelopment process which has been described as one important feature in the etiology of both diseases. In this paper, we will review the current knowledge on microtubular organization in olfactory neurons of patients with SZ and with BD that may constitute specific cytoskeletal endophenotypes and their relation with alterations in L-type voltage-activated Ca(2+) currents. Finally, the potential usefulness of neuronal precursors for pharmacological screening will be discussed. PMID:26837043

  14. Antipsychotic Medicines for Schizophrenia and Bipolar Disorder: What You Should Know

    MedlinePlus

    Antipsychotic Drugs for Schizophrenia and Bipolar Disorder: What You Should Know What are antipsychotic drugs? Antipsychotics are prescription drugs used to treat schizophrenia. They can also be used— ...

  15. Assessing and Interpreting Personality Change and Continuity in Patients Treated for Major Depression

    ERIC Educational Resources Information Center

    De Fruyt, Filip; Van Leeuwen, Karla; Bagby, R. Michael; Rolland, Jean-Pierre; Rouillon, Frederic

    2006-01-01

    Structural, mean- and individual-level, differential, and positive personality continuity were examined in 599 patients treated for major depression assigned to 1 of 6 forms of a 6-month pharmacy-psychotherapy program. Covariation among traits from the Five Factor model remained invariant across treatment, and patients described themselves as…

  16. Recognizing signs and symptoms of bipolar disorder.

    PubMed

    Carbray, Julie A; Iennaco, Joanne DeSanto

    2015-11-01

    Psychiatric mental health nurses and advanced practice nurses play an important role in the assessment and care of patients with bipolar disorder. Using appropriate rating scales and diagnostic criteria can aid in the assessment of patients who present with a variety of symptoms. In this game-based CME activity, you will assume the role of a psychiatric mental health advanced practice nurse who must recognize the signs and symptoms of bipolar disorder and select appropriate treatment for a 20-year-old patient with suicidal thoughts. PMID:26646046

  17. Relatives’ Emotional Involvement Moderates the Effects of Family Therapy for Bipolar Disorder

    PubMed Central

    Fredman, Steffany J.; Baucom, Donald H.; Boeding, Sara; Miklowitz, David J.

    2014-01-01

    Objective The “critical comments” dimension of the expressed emotion (EE) construct has been found to predict the illness course of patients with bipolar disorder, but less is known about the “emotional overinvolvement” (EOI) component. The goal of this study was to evaluate whether relatives’ observed appropriate and inappropriate emotional involvement (intrusiveness, self-sacrifice, and distress about patients’ well-being) moderated the effectiveness of a family-based intervention for bipolar disorder. Method 108 patients with bipolar disorder (mean age = 35.61 years [SD = 10.07]), 57% female) and their relatives (62% spouses) from two clinical trials completed 10-minute problem-solving interactions prior to being treated with pharmacotherapy plus family-based therapy (FBT) or brief psychoeducation (crisis management, CM). Patients were interviewed every 3–6 months over 2 years to assess mood symptoms. Results When relatives showed low levels of inappropriate self-sacrifice, CM and FBT were both associated with improvements in patients’ manic symptoms over 2 years. When relatives showed high levels, patients in CM became more manic over time, whereas patients in FBT became less manic. Group differences in mania trajectories were also observed at high levels of inappropriate emotional response but not at low. When relatives showed high levels of appropriate self-sacrifice, patients in both groups became less depressed. At low levels of appropriate self-sacrifice, patients in CM did not improve, whereas patients in FBT became less depressed. Conclusions Future studies of bipolar disorder should consider the prognostic value of the amount and appropriateness of relatives’ emotional involvement with patients in addition to their critical behaviors. PMID:25198285

  18. Anticonvulsant Drugs for Nerve Pain, Bipolar Disorder and Fibromyalgia

    MedlinePlus

    Anticonvulsant Drugs for Nerve Pain, Bipolar Disorder &Fibromyalgia: Choosing What’sRight for You What are anticonvulsant drugs? Anticonvulsants are drugs used to treat seizures. They are also used ...

  19. Demographic and Practice Characteristics of Psychiatrists who Primarily Treat Patients with Substance Use Disorders

    PubMed Central

    Montoya, Ivan D.; Herbeck, Diane M.; Svikis, Dace S.; Fitek, Diana J.; Marcus, Steven C.; Pincus, Harold A.

    2008-01-01

    This study examined the sociodemographic and practice characteristics of psychiatrists whose caseloads consist primarily of patients with Substance Use Disorders (SUD). A. survey instrument was completed by a random sample of 865 psychiatrists. Study groups were defined as high-SUD providers if psychiatrists reported having 51% or more patients with SUD (n = 92) and non-SUD providers as those who reported not having any patients with SUD (n = 128). High-SUD providers tended to be younger, more likely to graduate from international medical schools, have larger caseloads, work more hours per week, and have a higher proportion of inpatients and publicly funded patients than non-SUD providers. Results suggest that psychiatrists who primarily treat patients with SUD are in their early careers and treat patients with more clinical, psychosocial, and economic disadvantages. The implications of these findings for psychiatry training programs and policy makers will be discussed. PMID:12851014

  20. Fusing fMRI and DTI Measures of Brain Function and Structure to Predict Working Memory and Processing Speed Performance among Inter-episode Bipolar Patients

    PubMed Central

    McKenna, Benjamin S.; Theilmann, Rebecca J.; Sutherland, Ashley N.; Eyler, Lisa T.

    2015-01-01

    Objective Evidence for abnormal brain function as measured with diffusion tensor imaging (DTI) and functional magnetic resonance imaging (fMRI) and cognitive dysfunction have been observed in inter-episode bipolar disorder (BD) patients. We aimed to create a joint statistical model of white matter integrity and functional response measures in explaining differences in working memory and processing speed among BD patients. Method Medicated inter-episode BD (n=26, age=45.2±10.1yrs) and healthy comparison (HC; n=36, age=46.3±11.5yrs) participants completed 51-direction DTI and fMRI while performing a working memory task. Participants also completed a processing speed test. Tract-based spatial statistics identified common white matter tracts where fractional anisotropy was calculated from atlas-defined regions of interest. Brain responses within regions of interest activation clusters were also calculated. Least angle regression was used to fuse fMRI and DTI data to select the best joint neuroimaging predictors of cognitive performance for each group. Results While there was overlap between groups in which regions were most related to cognitive performance, some relationships differed between groups. For working memory accuracy, BD-specific predictors included bilateral dorsolateral prefrontal cortex from fMRI, splenium of the corpus callosum, left uncinate fasciculus, and bilateral superior longitudinal fasciculi from DTI. For processing speed, the genu and splenium of the corpus callosum and right superior longitudinal fasciculus from DTI were significant predictors of cognitive performance selectively for BD patients. Conclusions BD patients demonstrated unique brain-cognition relationships compared to HC. These findings are a first step in discovering how interactions of structural and functional brain abnormalities contribute to cognitive impairments in BD. PMID:26037664

  1. Validation of a specific measure to assess health-related quality of life in patients with schizophrenia and bipolar disorder: the 'Tolerability and quality of life' (TOOL) questionnaire

    PubMed Central

    2011-01-01

    Background Perception of quality of life may differ depending on the perspective. The aim of the study was to assess the psychometric properties of the Spanish version of the 'TOlerability and quality Of Life' (TOOL) questionnaire, a specific self-rated instrument to evaluate the impact of side effects of antipsychotic drugs on health-related quality of life (HRQoL). The questionnaire consists of eight items answered on a four-point Likert scale. Methods A psychometric study was conducted with clinically stable outpatients with schizophrenia and bipolar disorder under antipsychotic treatment. The translation and cultural adaptation of the questionnaire was performed according to international standards. Internal consistency using the Cronbach α coefficient and test-retest reliability using the intraclass correlation coefficient (ICC) was used to assess the reliability of the instrument. Patients completed generic and specific measures of quality of life and clinical severity. Results A total of 238 patients were analysed, with a mean age of 42 years (SD 10.9). The mean completion time was 4.9 min (SD 4.4). Internal consistency and intraclass correlation coefficient were adequate (Cronbach α = 0.757 and ICC = 0.90). Factorial analysis showed a unidimensional structure (a single eigenvalue >1, accounting for 39.1% of variance). Significant Spearman's rank correlations between the TOOL and both generic and specific measures were found. The questionnaire was able to discriminate among the Clinical Global Impression - Severity scores (Mann-Whitney U test, P < 0.001). Conclusions The TOOL questionnaire shows appropriate feasibility, reliability, and discriminative performance as a patient-reported outcome. TOOL constitutes a valuable addition to measure the impact of adverse events of antipsychotic drugs from the patient perspective. PMID:21396102

  2. Adherence and resource use among patients treated with biologic drugs: findings from BEETLE study

    PubMed Central

    Degli Esposti, Luca; Sangiorgi, Diego; Perrone, Valentina; Radice, Sonia; Clementi, Emilio; Perone, Francesco; Buda, Stefano

    2014-01-01

    Objectives Systemic administration of anti-tumor necrosis factor alpha (anti-TNF alpha) leads to an anti-inflammatory and joint protective effect in pathologies such as rheumatoid arthritis, psoriasis, and Crohn’s disease. The aim of this study was to assess adherence to therapy, persistence in treatment (no switches or interruptions), and consumption of care resources (drugs, outpatient services, hospitalizations). Methods We conducted an observational retrospective cohort analysis using the administrative databases of five local health units. Patients filling at least one prescription for anti-TNF alpha between January 1, 2009 and December 31, 2011 were included and followed up for 1 year. Patients were defined as adherent if >80% of the follow-up period was covered by drugs dispensation. Results A total of 1,219 patients were analyzed (mean age 49.6±14.6, male 47%). Among enrolled patients, 36% were affected by rheumatoid arthritis, and 31% and 10% were affected by psoriasis and Crohn’s disease, respectively; other indications remained below these percentages. Thirty-four percent of patients (420) were treated with adalimumab, 51% (615) with etanercept, and 15% (184) with infliximab. Among the 94% of patients who did not switch, those treated with infliximab had a higher rate of adherence across all indications (51% overall) when compared to that observed in patients treated with etanercept (27%) or adalimumab (23%). The mean annual nonpharmacological expenditure for each patient in analysis was €988 for adherent and €1,255 for nonadherent patients. Infliximab was associated with the lowest cost for all indications as determined by the multivariate generalized linear model. Conclusions Patients treated with infliximab were associated with higher adherence and persistence in treatment and lower costs, as compared to those treated with adalimumab or etanercept. PMID:25258545

  3. Association between obstructive sleep apnea severity and glucose control in patients with untreated versus treated diabetes.

    PubMed

    Priou, Pascaline; Le Vaillant, Marc; Meslier, Nicole; Chollet, Sylvaine; Pigeanne, Thierry; Masson, Philippe; Bizieux-Thaminy, Acya; Humeau, Marie-Pierre; Goupil, François; Ducluzeau, Pierre-Henri; Gagnadoux, Frédéric

    2015-08-01

    The purpose of this study was to determine whether the association between obstructive sleep apnea severity and glucose control differs between patients with newly diagnosed and untreated type 2 diabetes, and patients with known and treated type 2 diabetes. This multicentre cross-sectional study included 762 patients investigated by sleep recording for suspected obstructive sleep apnea, 497 of whom were previously diagnosed and treated for type 2 diabetes (treated diabetic patients), while 265 had no medical history of diabetes but had fasting blood glucose ≥126 mg dL(-1) and/or glycated haemoglobin (HbA1c ) ≥6.5% consistent with newly diagnosed type 2 diabetes (untreated diabetic patients). Multivariate regression analyses were performed to evaluate the independent association between HbA1c and obstructive sleep apnea severity in treated and untreated patients with diabetes. In untreated diabetic patients, HbA1c was positively associated with apnea-hypopnea index (P = 0.0007) and 3% oxygen desaturation index (P = 0.0016) after adjustment for age, gender, body mass index, alcohol habits, metabolic dyslipidaemia, hypertension, statin use and study site. The adjusted mean value of HbA1c increased from 6.68% in the lowest quartile of the apnea-hypopnea index (<17) to 7.20% in the highest quartile of the apnea-hypopnea index (>61; P = 0.033 for linear trend). In treated patients with diabetes, HbA1c was associated with non-sleep variables, including age, metabolic dyslipidaemia and insulin use, but not with obstructive sleep apnea severity. Obstructive sleep apnea may adversely affect glucose control in patients with newly diagnosed and untreated type 2 diabetes, but may have a limited impact in patients with overt type 2 diabetes receiving anti-diabetic medications. PMID:25703309

  4. [Non pharmacological treatment for bipolar disorder].

    PubMed

    Mirabel-Sarron, Christine; Giachetti, Raphaël

    2012-12-01

    Bipolar disorder is a chronic and recurring disorder associated with significant psychosocial impairment. A number of psychosocial interventions have been developed to address impairment. The consensus makes mood stabilizer the treatment of bipolar disorder. However, numerous patients are not in complete remission despite a controlled observance. Every patient can follow a psycho educational program. What this paper adds. The review identifies that a range of interventions have demonstrated efficacy in extended periods of euthymia, improved social and occupational functioning and alleviation of subsyndromal symptoms. Adjunctive, short-term psychotherapies have been shown to offer fairly consistent benefits to bipolar disorder patients. Cognitive-behavioural therapy, family-focused therapy, and psychoeducation offer the most robust efficacy in regard to relapse prevention. The most complex situations including comorbidities can be helped by behavioral and cognitive therapy for bipolar disorder. Evaluations emphasize positive impact. The psychosocial interventions reviewed provide mental health nurses with evidence-based approaches to improving mental health care for patients with bipolar disorder. There is a need for mental health nurses to conduct high quality trials of the clinical effectiveness of these interventions. PMID:23395231

  5. The Clinical Management of Bipolar Disorder: A Review of Evidence-Based Guidelines

    PubMed Central

    Thase, Michael E

    2011-01-01

    Objective: To discuss the criteria used to diagnose the mood episodes that constitute bipolar disorder, the approach to the differential diagnosis of these presentations, and the evidence-based treatments that are currently available. Data Sources: A search for evidence-based guidelines for the diagnosis and treatment of adults with bipolar disorder was performed on May 5, 2010, using the National Guideline Clearinghouse database, the Agency for Healthcare Research and Quality Evidence Reports database, and the Cochrane Database of Systematic Reviews. In addition, a clinical query of the PubMed database (completed March 1, 2010) and searches of drug manufacturers’ Web sites (for unpublished trials) were performed to identify randomized, controlled trials and meta-analyses evaluating strategies to treat resistant depression. Study Selection: Guidelines were selected based on data from randomized, controlled trials; meta-analyses; and well-conducted naturalistic trials that were published since 2005. Data Extraction: Four evidence-based treatment guidelines for bipolar disorder were included. Three were published in 2009: those put forth as part of an Australian project, those of the British Association for Psychopharmacology, and those produced by the International Society for Bipolar Disorders and the Canadian Network for Mood and Anxiety Treatments. The most recent US guidelines are that of the Texas Implementation of Medication Algorithms project, last updated in 2005. Data Synthesis: Recommendations from all 4 guidelines were reviewed and are presented with a focus on using them to improve clinical care. The recommendations with the most agreement and highest level of clinical evidence were as follows: (1) mania should be treated first-line with lithium, divalproex, or an atypical antipsychotic medication; (2) mixed episodes should be treated first-line with divalproex or an atypical antipsychotic; (3) bipolar depression should be treated with quetiapine

  6. Neuroleptic malignant syndrome in a patient treated with lithium carbonate and haloperidol.

    PubMed

    Yang, Yanfen; Guo, Yahui; Zhang, Aiguo

    2014-12-01

    A 39-year-old female with a 20-year history of bipolar disorder was admitted due to a recurrence of a manic episode with psychotic symptoms. She was treated with standard doses of lithium carbonate and clozapine. Three days after admission, she showed aggressive behavior and refused to take her medications so her oral clozapine was switched to intramuscular haloperidol. Three days later she developed a high temperature and exhibited symptoms of neuroleptic malignant syndrome (NMS) including excessive sweating, cramps and tremors in limb muscles, muscle rigidity, and impaired consciousness. The haloperidol and lithium were stopped immediately, symptomatic treatment was provided, and she was administered the dopamine agonist bromocriptine. The NMS symptoms resolved within three days but she continued to have severe psychotic symptoms. She was subsequently re-challenged with valproate and olanzapine but the NMS did not re-occur. After one month of this treatment she recovered and was discharged. Several case histories similar to this one suggest - but do not prove - that individuals concurrently receiving lithium and antipsychotic medications may be at higher risk of developing NMS than those receiving monotherapy with antipsychotic medication. PMID:25642114

  7. Treatment of bipolar depression.

    PubMed

    Musetti, Laura; Del Grande, Claudia; Marazziti, Donatella; Dell'Osso, Liliana

    2013-08-01

    Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder. PMID:23391164

  8. Sideroblastic anemia as a preleukemic event in patients treated for Hodgkin's disease

    SciTech Connect

    Kitahara, M.; Cosgriff, T.M.; Eyre, H.J.

    1980-05-01

    Sideroblastic anemia after treatment for Hodgkin's disease was seen in two patients 3 years after completion of radiation therapy and chemotherapy. This was followed in both by the development of myelomonoblastic leukemia. No evidence of recurrent Hodgkin's disease was present in either patient. Our observation suggests that development of sideroblastic anemia in patients previously treated for Hodgkin's disease is probably secondary to the treatment and is a preleukemic event.

  9. Behavioral and neural correlates of self-referential processing deficits in bipolar disorder

    PubMed Central

    Zhao, Yanli; Luo, Wenbo; Chen, Jingxu; Zhang, Dandan; Zhang, Ligang; Xiao, Chunling; Fan, Fengmei; Zhu, Xiaolin; Fan, Hongzhen; Tan, Shuping

    2016-01-01

    Self-referential processing is a core component of social cognition. However, few studies have focused on whether self-referential processing deficits present in bipolar disorder. The current study combined a high-time-resolution event-related potential (ERP) technique with the self-referential memory (SRM) task to evaluate self-referential processing in 23 bipolar patients and 27 healthy controls. All subjects showed a reliable SRM effect, but the bipolar group had poorer recognition scores for the self- and other-referential conditions. The bipolar group presented with smaller voltages in both the self- and other-referential conditions for the N1 (150–220 ms) and the P2 components (130–320 ms) but larger voltages in the positive slow wave (600–1600 ms) component. Larger P3 amplitudes were elicited in the self-referential condition compared with the other-referential condition in controls but not in bipolar patients. Additionally, non-psychotic bipolar patients had a comparative normal SRM effect which was abolished in psychotic bipolar patients; non-psychotic bipolar patients had larger amplitudes of the positive slow wave than the normal controls, whereas it was not differed between psychotic bipolar patients and the healthy subjects. The present study suggests that self- and other-referential processing is impaired in bipolar patients and the deficits may be more pronounced in psychotic bipolar patients. PMID:27052432

  10. The use of bipolar technology in hysteroscopy.

    PubMed

    Calabrese, Stefania; DE Alberti, Davide; Garuti, Giancarlo

    2016-04-01

    Bipolar technology was introduced in the hysteroscopic clinical use in 1999, by the design of both loop electrodes addressed to resectoscopic surgery and miniaturized electrodes adaptable to small-size hysteroscopes. The need of an electrolytic solution as distension medium and the spatial relationships between the active and return bipolar electrode avoid, by definition, the risks of severe electrolyte imbalance syndromes and unpredictable electrical burns, sometimes complicating monopolar surgery. The true revolution in the hysteroscopy care has achieved through the availability of mini-hysteroscopes not requiring cervical dilatation, thus limiting uterine wall damages and allowing surgeons to manage several endometrial pathologies by mini-invasive procedures using an effective electrosurgical bipolar instrumentation. Many surgical interventions, traditionally accomplished by the resectoscope in a surgical room theatre, can be now carried out in an outpatient setting without any support from anesthesia. The patients' avoidance of surgical room access and the quick return to daily activities lead to an obvious - but not fully demonstrated - improvement in the medical and social costs associated to outpatient operative hysteroscopy. In the field of resectoscopy, bipolar electrodes are clinically as effective as monopolar devices. Randomized trials showed that bipolar resectoscopic technology prevents the electrolyte imbalance observed after monopolar surgery. However, in daily clinical practice the assumedly safer profile of bipolar with respect to monopolar resectoscopy has not been demonstrated yet. PMID:26928415

  11. Muscle mitochondrial metabolism and calcium signaling impairment in patients treated with statins

    SciTech Connect

    Sirvent, P.; Fabre, O.; Bordenave, S.; Hillaire-Buys, D.; Raynaud De Mauverger, E.; Lacampagne, A.; Mercier, J.

    2012-03-01

    The most common and problematic side effect of statins is myopathy. To date, the patho-physiological mechanisms of statin myotoxicity are still not clearly understood. In previous studies, we showed that acute application in vitro of simvastatin caused impairment of mitochondrial function and dysfunction of calcium homeostasis in human and rat healthy muscle samples. We thus evaluated in the present study, mitochondrial function and calcium signaling in muscles of patients treated with statins, who present or not muscle symptoms, by oxygraphy and recording of calcium sparks, respectively. Patients treated with statins showed impairment of mitochondrial respiration that involved mainly the complex I of the respiratory chain and altered frequency and amplitude of calcium sparks. The muscle problems observed in statin-treated patients appear thus to be related to impairment of mitochondrial function and muscle calcium homeostasis, confirming the results we previously reported in vitro. -- Highlights: ► The most common and problematic side effect of statins is myopathy. ► Patients treated with statins showed impairment of mitochondrial respiration. ► Statins-treated patients showed altered frequency and amplitude of calcium sparks.

  12. MGMT inactivation and clinical response in newly diagnosed GBM patients treated with Gliadel.

    PubMed

    Grossman, Rachel; Burger, Peter; Soudry, Ethan; Tyler, Betty; Chaichana, Kaisorn L; Weingart, Jon; Olivi, Alessandro; Gallia, Gary L; Sidransky, David; Quiñones-Hinojosa, Alfredo; Ye, Xiaobu; Brem, Henry

    2015-12-01

    We examined the relationship between the O(6)-methylguanine-methyltransferase (MGMT) methylation status and clinical outcomes in newly diagnosed glioblastoma multiforme (GBM) patients who were treated with Gliadel wafers (Eisai, Tokyo, Japan). MGMT promoter methylation has been associated with increased survival among patients with GBM who are treated with various alkylating agents. MGMT promoter methylation, in DNA from 122 of 160 newly diagnosed GBM patients treated with Gliadel, was determined by a quantitative methylation-specific polymerase chain reaction, and was correlated with overall survival (OS) and recurrence-free survival (RFS). The MGMT promoter was methylated in 40 (32.7%) of 122 patients. The median OS was 13.5 months (95% confidence interval [CI] 11.0-14.5) and RFS was 9.4 months (95% CI 7.8-10.2). After adjusting for age, Karnofsky performance score, extent of resection, temozolomide (TMZ) and radiation therapy (RT), the newly diagnosed GBM patients with MGMT methylation had a 15% reduced mortality risk, compared to patients with unmethylated MGMT (hazard ratio 0.85; 95% CI 0.56-1.31; p=0.46). The patients aged over 70 years with MGMT methylation had a significantly longer median OS of 13.5 months, compared to 7.6 months in patients with unmethylated MGMT (p=0.027). A significant difference was also found in older patients, with a median RFS of 13.1 versus 7.6 months for methylated and unmethylated MGMT groups, respectively (p=0.01). Methylation of the MGMT promoter in newly diagnosed GBM patients treated with Gliadel, RT and TMZ, was associated with significantly improved OS compared to the unmethylated population. In elderly patients, methylation of the MGMT promoter was associated with significantly better OS and RFS. PMID:26249244

  13. Metabolic syndrome - the consequence of lifelong treatment of bipolar affective disorder.

    PubMed

    Dadić-Hero, Elizabeta; Ruzić, Klementina; Grahovac, Tanja; Petranović, Duska; Graovac, Mirjana; Palijan, Tija Zarković

    2010-06-01

    Mood disturbances are characteristic and dominant feature of Mood disorders. Bipolar Affective Disorder (BAD) is a mood disorder which occurs equally in both sexes. BAD may occur in co morbidity with other mental diseases and disorders such as: Anorexia Nervosa, Bulimia Nervosa, Attention Deficit, Panic Disorder and Social Phobia. However, medical disorders (one or more) can also coexist with BAD. Metabolic syndrome is a combination of metabolic disorders that increase the risk of developing cardiovascular disease. A 61-year old female patient has been receiving continuous and systematic psychiatric treatment for Bipolar Affective Disorder for the last 39 years. The first episode was a depressive one and it occurred after a child delivery. Seventeen years ago the patient developed diabetes (diabetes type II), and twelve years ago arterial hypertension was diagnosed. High cholesterol and triglyceride levels as well as weight gain were objective findings. During the last nine years she has been treated for lower leg ulcer. Since metabolic syndrome includes abdominal obesity, hypertension, diabetes mellitus, increased cholesterol and serum triglyceride levels, the aforesaid patient can be diagnosed with Metabolic Syndrome. When treating Bipolar Affective Disorder, the antipsychotic drug choice should be careful and aware of its side-effects in order to avoid the development or aggravation of metabolic syndrome. PMID:20562789

  14. Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder

    PubMed Central

    Hsieh, Christina J.; Godwin, Douglass; Mamah, Daniel

    2016-01-01

    Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are limited. Thus, individuals at earlier stages of illness are often not identified. The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) screen is a self-report questionnaire originally developed to identify clinical risk for developing bipolar or psychotic disorders. The goal of the current study was to investigate the utility of the WERCAP Screen and two complementary questionnaires, the WERC Stress Screen and the WERC Substance Screen, in identifying individuals with established SCZ or BPD. Participants consisted of 35 BPD and 34 SCZ patients, as well as 32 controls (CON), aged 18–30 years. Univariate analyses were used to test for score differences between groups. Logistic regression and receiver operating characteristic (ROC) curves were used to identify diagnostic predictors. Significant group differences were found for the psychosis section of the WERCAP (pWERCAP; p < 0.001), affective section of the WERCAP (aWERCAP; p = 0.001), and stress severity (p = 0.027). No significant group differences were found in the rates of substance use as measured by the WERC Substance Screen (p = 0.267). Only the aWERCAP and pWERCAP scores were useful predictors of diagnostic category. ROC curve analysis showed the optimal cut point on the aWERCAP to identify BPD among our participant groups was a score of >20 [area under the curve (AUC): 0.87; sensitivity: 0.91; specificity: 0.71], while that for the pWERCAP to identify SCZ was a score of >13 (AUC: 0.89; sensitivity: 0.88; specificity: 0.82). These results indicate that the WERCAP Screen may be useful in screening individuals for BPD and SCZ and that identifying stress and substance-use severity can be

  15. Utility of Washington Early Recognition Center Self-Report Screening Questionnaires in the Assessment of Patients with Schizophrenia and Bipolar Disorder.

    PubMed

    Hsieh, Christina J; Godwin, Douglass; Mamah, Daniel

    2016-01-01

    Early identification and treatment are associated with improved outcomes in bipolar disorder (BPD) and schizophrenia (SCZ). Screening for the presence of these disorders usually involves time-intensive interviews that may not be practical in settings where mental health providers are